How Psychology Works - The Facts Visually Explained

PSYCHOLOGICAL DISORDERS 48 49
Specific phobias

BLOOD-INJECTION-INJURY NATURAL ENVIRONMENT
A unique group of phobias in which the sight of A person with a phobia from this group has
blood or needles causes a vasovagal reaction—a an irrational fear of a natural event, which they often
associate with imagery of potentially catastrophic
reflex action that slows down the heart rate, outcomes. Examples of this type of phobia include
reducing blood flow to the brain—that can storms; deep water; germs; and fear of heights, such
result in fainting. Unlike all other phobias, this
is as common in males as it is in females. as being near a cliff edge.

WATER LIGHTNING

NEEDLES BLOOD

HEIGHTS

SITUATIONAL
These are a group of phobias of being
in a specific situation, which can range

from visiting the dentist’s office to
stepping into an old elevator, flying,
driving over a bridge or through a

tunnel, or getting into a car.

ANIMAL FLYING BRIDGES
This group of phobias includes
insects, snakes, mice, cats, dogs, and OTHER PHOBIAS
birds, among other animals. It could be Thousands of people are tormented
rooted in a genetic predisposition by an array of phobias, including fear of
for survival from animals that were vomiting; a specific color, for example, anything
a threat to human ancestors. that is yellow or red (including foodstuffs); the
number 13; the sight of a belly button or toes;
sudden loud noises; costumed characters, such
as clowns; trees; or contact with cut flowers.

SNAKES SPIDERS RATS

TREES CLOWNS

Agoraphobia

This is an anxiety disorder characterized by a fear of being
trapped in any situation in which escape is difficult or rescue
is unavailable if things go wrong.

What is it? experience is accompanied by experience. In the UK, one-third of
negative thoughts—for example, those who have panic attacks go on
Agoraphobia is a complex phobia the person may think that as well to develop agoraphobia. Biological
that is not, as many think, simply a as being trapped they are going to and psychological factors are the
fear of open spaces. The individual look ridiculous, because they are probable cause. Experiencing or
dreads being trapped, and avoids out of control in public. The witnessing a traumatic event,
whatever triggers the terror of symptoms, or fear of them, are mental illness, or an unhappy
being unable to escape. The result disruptive and result in avoidance relationship may play a part.
can be a fear of traveling on public behaviors that make leading a
transport, being in an enclosed normal life hard. Treatment can help—about
space or a crowd, going shopping one-third are cured and 50 percent
or to health appointments, or Agoraphobia can develop if an find that symptoms improve. A GP
leaving the house. The associated individual has a panic attack, then first excludes other conditions that
panic attack brought on by such an worries excessively about a repeat may be causing the symptoms.

SYMPTOMS “Nothing diminishes
anxiety faster than action.”
PHYSICAL
Rapid heart and breathing Walter Inglis Anderson, American painter, writer, and naturalist
rate, chest pain, dizziness,
shaking, feeling nauseous, and TREATMENT
breathing problems.
BEHAVIORAL ❯❯Intensive psychotherapy such as cognitive behavioral
Excessive planning to avoid therapy (p.125) to explore the thoughts that maintain the
crowds, lines, and public phobia; behavioral experiments to gather evidence that
transport, or not going out at all defuses strongly held beliefs.
or only with a trusted person.
❯❯Self-help groups using safe visual material to work on
exposure to the feared situation; teaching how to manage
a panic attack by breathing slowly and deeply.

❯❯Lifestyle management such as exercise and a healthy diet.

COGNITIVE Types of symptoms
Predictions of shaming by
others, overthinking potential The symptoms of agoraphobia are classified into three types:
disasters, catastrophic thoughts the physical symptoms that a person experiences in the
of being trapped or injured, feared situation; behavioral patterns associated with the fear;
and feeling out of control. and cognitive symptoms—the thoughts and feelings a person
has when anticipating or living with the fear. The combination
can make it difficult for a person to function day to day.

Claustrophobia 50 51

An irrational fear of becoming trapped in a confined space or even
the anticipation of such a situation, claustrophobia is a complex
phobia that can cause extreme anxiety and panic attacks.

What is it? confined in a tiny room or was TREATMENT
bullied or abused. The condition
For a person with claustrophobia, can also be triggered by unpleasant ❯❯Cognitive behavioral therapy
being confined induces physical experiences at any stage of life, (p.125) to reevaluate negative
symptoms similar to those of such as turbulence on a flight or thoughts through exposure to the
agoraphobia (opposite). The fear being trapped in an elevator. The feared situation in small steps so
also increases negative thoughts of individual fears a repeat of being the individual realizes that the
running out of oxygen or suffering confined and overimagines what worst fear does not occur.
a heart attack with no chance of could happen in a small space.
escape. Many individuals also As a result they plan their daily ❯❯Anxiety management to cope
experience feelings of dread and activities carefully to minimize the with anxiety and panic by using
fear of fainting or losing control. likelihood of “becoming trapped.” breathing techniques, muscle
relaxation, and visualization of
Claustrophobia may be caused by Sometimes claustrophobia is positive outcomes.
conditioning (pp.16–17) following a observed in other family members,
stressful situation that occurred in which suggests a genetic ❯❯Anti-anxiety medication or
a small space. This might be traced vulnerability to the disorder and/or antidepressants (pp.142–143)
back to childhood, when, for a learned associated response. prescribed in extreme cases.
example, an individual was

FEAR OF CONFINED SPACES is normal if the threat is genuine, but a person with claustrophobia has an irrational fear regardless of actual danger.

GAD (generalized
anxiety disorder)

People with this disorder experience continual unrestrained and
uncontrollable worry (even when no danger is present), to the extent
that day-to-day activity and functioning can become impaired.

What is it? matters, work, health, school, or resolve one worry another appears.
specific events. A person with GAD They overestimate the likelihood of
An individual with GAD worries experiences feelings of anxiety bad or dangerous things happening
excessively about a wide range of most days, and as soon as they and predict the worst possible
issues and situations. Symptoms outcome. The individual may even
include “threat” reactions such as Social fears report positive beliefs about the
heart palpitations, trembling, helpfulness of worry, such as
sweating, irritability, restlessness, moHneeyalwthoorrries “Worrying makes it less likely that
and headaches. GAD can also bad things will happen.” Long-term
cause insomnia and difficulty in Anticaipnadtidoinsaosftedrasngers or habitual avoidance of fearful
concentrating, making decisions, situations or places compounds the
or dealing with uncertainty. Perfectionism disorder, because the individual
never gathers evidence that their
The person may become fears are unfounded, thus
obsessed with perfectionism, maintaining the worry.
or with planning and controlling
events. The physical and 60%Women are
psychological symptoms can have
a debilitating effect on social more likely to
interactions, work, and everyday develop GAD
activities, leading to lowered than men
confidence and isolation. Worries
may revolve around family or social Balancing worries

TREATMENT Anxiety becomes a problem when
a person is weighed down with
❯❯Cognitive behavioral therapy worries for the majority of days
(p.125) to identify triggers, in a six-month period or longer.
negative thoughts, habitual
avoidance, and safety behaviors.

❯❯Behavioral therapy (p.124) to
identify new behavioral goals,
with achievable steps.

❯❯Group therapy with
assertiveness training and
building self-esteem to help
counteract unhelpful beliefs
and unfounded fears.

Social anxiety 52 53
disorder

Individuals with this condition experience an overwhelming fear
of being judged or of doing something embarrassing in social
situations. The disorder can cause disabling self-consciousness.

What is it? have come across. Social anxiety TREATMENT
causes the person to overplan and
An individual with social anxiety rehearse for anticipated situations, ❯❯Cognitive behavioral therapy
disorder (also called social phobia) which may lead to odd or awkward (p.125) to recognize and change
experiences excessive nerves or behavior. Individuals may then negative thought patterns and
dread of social situations. They gather evidence to support their behaviors.
may be anxious only in specific fears, because difficult situations
circumstances, such as speaking or often arise as a result of the ❯❯Group therapy for the
performing in public, or experience person’s anxiety or over-rehearsal. opportunity to share problems
distress in all social situations. and practice social behavior.
This disorder leads to isolation
The person tends to be extremely and depression and can seriously ❯❯Self-help including affirmations,
self-conscious and worries about affect social relationships. It can rehearsing before social events,
others evaluating them negatively. also have a negative impact on and using video feedback to
They dwell on past social incidents, performance at work or school. disprove negative assumptions.
obsessing about how they might

SYMPTOMS BEFORE DURING INTERACTION AFTER INTERACTION
SOCIAL INTERACTION Physical symptoms such The person conducts
The individual may as trembling, rapid a detailed, negative,
prepare and rehearse breathing, racing heart, and self-critical
excessively in advance, sweating, or blushing appraisal of the social
planning topics of occur as the body’s situation, dissecting
conversation or how “fight or flight” system conversations and
to present themselves is activated. In extreme body language
in a specific way. cases, the person may and giving them
experience a panic attack. a negative slant.

Separation anxiety
disorder

This anxiety disorder can develop in children whose natural concern
about being separated from their parent, primary caregiver, or home
persists beyond the age of two years.

What is it? school and social occasions can reason. Older children may
anticipate feelings of panic and
Separation anxiety is a normal also be a trigger. Affected children struggle to travel independently.

adaptive reaction that helps to keep may experience panic attacks, Separation is the most common
anxiety disorder in children under
babies and toddlers safe while they disturbed sleep, clinginess, and 12 years old. It can also affect older
children, and it may be diagnosed
attain competence to cope with inconsolable crying. They may in adulthood. The disorder can
develop after a major stressor such
their environment. However, it can complain of physical problems such as the loss of a loved one or pet,
moving, changing schools, or
be a problem if it persists for more as stomachache, headache, or just parents’ divorce. Overprotective or
intrusive parenting can contribute.
than four weeks and interferes feeling unwell for no apparent
Separation anxiety is very
with age-appropriate behavior. treatable with behavioral therapies
that include building planned
The child becomes distressed separations into times of the day
when the person is feeling least
when they need to leave vulnerable.

a primary caregiver and fears VIVID FEARS TREATMENT
The child worries
that harm will come to that excessively about being ❯❯Cognitive behavioral therapy
person. Situations such as detached from their (p.125) for anxiety management;
primary caregiver—even if assertiveness training for older
Being alone only in a separate room. children and adults.

Worries about losing ❯❯Parent training and support
their primary caregiver are to promote and reinforce short
common, and the child periods of separation that are
may relive their daytime then extended gradually.
fears in nightmares. They
may refuse to sleep alone ❯❯Anti-anxiety medication
or suffer from insomnia. and antidepressants (pp.142–
143) for older individuals, in
UNWANTED BURDEN combination with environmental
Anxious feelings may manifest and psychological interventions.
themselves as physical pains as the child
struggles to fix their panic of separation
onto something tangible.

Selective mutism 54 55

This is an anxiety disorder in which people are unable to talk in
certain social situations, but are able to speak at other times. It is
usually first recognized between the ages of three and eight years.

What is it? or school. Treating the condition TREATMENT
can prevent it from persisting into
Selective mutism is associated adulthood—the younger the child ❯❯Cognitive behavioral therapy
with anxiety, and children who is when diagnosed, the easier it is (p.125) using positive and negative
are affected by it struggle with to treat. reinforcements to build speech
excessive fears and worries. They and language skills; graded
are generally able to speak freely If symptoms persist for more exposure to specific situations to
where they feel comfortable but are than a month, the child should be reduce anxiety, removing pressure
unable to talk in specific situations, seen by a GP, who can refer them on the child to speak.
when they do not engage, go still, for speech and language therapy.
or have a frozen facial expression A specialist asks whether there is ❯❯Psychoeducation (p.113) can
when expected to talk. This a history of anxiety disorders, a provide information and support
inability to speak is not the result likely stressor, or a hearing problem. for parents and caregivers, relieve
of a conscious decision or a refusal. Treatment depends on how long general anxiety, and reduce
the child has had the condition, the chances of the disorder persisting.
The mutism can be triggered by presence of learning difficulties
a stressful experience, or it can or anxieties, and the support that
stem from a speech or language is available.
disorder, or hearing problem, that
makes social situations involving “It is a child suffering in silence.”
communication particularly
stressful. Whatever the cause, Dr. Elisa Shipon-Blum, American president of Selective Mutism Anxiety
everyday activities are difficult, as Research and Treatment Center
are relationships within the family

State of fear

Children with selective
mutism literally “freeze”
when they are expected to
talk, and make little or no
eye contact. The condition
is more common in
children who are learning
a second language.

OCD (obsessive
compulsive disorder)

This is a debilitating anxiety-related condition characterized by
intrusive and unwelcome obsessive thoughts that are often
followed by repetitive compulsions, impulses, or urges.

What is it? (below) and often starts with The obsessive thoughts and
an obsessive thought, which compulsions are time-
OCD is often marked by thoughts the person focuses on, in turn consuming, and individuals may
that reflect an excessive sense of raising anxiety levels. Checking struggle to function day to day
responsibility for keeping others everything is in order and following or have a disrupted social or
safe and an overestimation of the rituals can provide relief, but the family life. The disorder may
perceived threat an intrusive distressing thought returns. be triggered by an event in the
thought signifies. OCD is cyclical

OBSESSIONS Obsession Anxiety Compulsion
(THOUGHTS)
TAKES UP
Fear of causing harm AT LEAST
ONE HOUR
Excessive attention paid to PER DAY
thoughts about actions that
could cause harm. Temporary relief

Intrusive thoughts

Obsessive, repetitive, and even
disturbing thoughts about
causing harm.

Fear of contamination

Thinking that something is dirty
or germ-ridden and will cause
illness or death to the person or
someone else.

Fear related to order
or symmetry

Concern that harm could result
unless tasks are done in a
specific order.

PSYCHOLOGICAL DISORDERS 56 57
OCD (obsessive compulsive disorder)

person’s history that they felt “An average TREATMENT

highly responsible for. Family person can have ❯❯Cognitive behavioral therapy
history, differences in the brain, (p.125) involving exposure to
triggers and learning how to
and personality traits also play a control responses.

four thousandpart. An examination of thoughts, ❯❯Anti-anxiety medication and/or
feelings, and behavior patterns thoughts a day, antidepressants (pp.142–143) to
determines OCD, but its similarity and not all of help relieve symptoms of
to other anxiety disorders can make them are useful depression and anxiety.
diagnosis difficult. or rational.”
❯❯Specialist residential treatment
With pure OCD, a person has in addition to therapy and
intrusive and disturbing thoughts medication for extremely severe
about harming people, but rather cases of OCD.

than performing observable David Adam, British author
compulsions, their compulsions

take place in the mind.

COMPULSIONS
(BEHAVIORS)

Rituals

Following rituals such as
counting or tapping to prevent
harm and provide relief from
the cycle of fear.

Constant checking

Examining household
appliances, lights, taps, locks,
windows (to counter fear of
causing harm by fire), driving
routes (fear of having run a
person over), or people (fear
of upsetting someone).

Correcting thoughts

Trying to neutralize thoughts
to prevent disasters.

Reassurance

Repeatedly asking others to
confirm everything is OK.

FOLLOWING RITUALS and constant checking that everything is in order and safe are
the main features of OCD.

Hoarding disorder

Also known as compulsive hoarding, this disorder is characterized
by the excessive acquisition of, and/or the inability or unwillingness
to dispose of, large quantities of objects.

What is it? does not see it as a problem and TREATMENT
experiences such overwhelming
Hoarding disorder may begin as a discomfort at reducing the clutter ❯❯Cognitive behavioral therapy
way of coping with a stressful life that they avoid any attempt to do (p.125) to examine and weaken
event. The individual with does not so. Alternatively, the person may be the thoughts that maintain the
discard worn-out possessions, for aware of the problem but too hoarding behavior and allow
fear either of needing them again ashamed to seek help or advice. adaptive or flexible alternatives
or of something bad happening to to emerge.
other people if they get rid of Hoarding may be part of other
anything. They store sentimental disorders such as OCD (pp.56–57), ❯❯Lifestyle management at home
items because they believe that severe depression (pp.38–39), or to motivate reducing clutter for
discarding them will keep psychotic disorders (pp.70–75). In health and safety reasons.
emotional needs from being met. assessment, the doctor questions
The individual continues to the person about their feelings ❯❯Antidepressants (pp.142–143)
accumulate items even when space on acquiring objects and their to decrease the associated anxiety
is running out. Hoarding can be overestimation of responsibility for and depression.
hard to treat because the person causing harm by discarding items.

Living with
hoarding

A person with hoarding
disorder may let junk mail, bills,
receipts, and heaps of paper
pile up. The resulting clutter
can pose a health and safety
risk and makes it hard to move
from room to room, which is
distressing for the individual
and affects their, and their
family’s, quality of life. This may
lead to isolation and impaired
or difficult relationships with
other people.

BDD (body 58 59

dysmorphic disorder)

In this condition a person has a distorted perception of how they
look. The individual typically spends an excessive amount of time
worrying about their appearance and how others view them.

What is it? and it often occurs alongside OCD development. In assessment,
(pp.56–57) or generalized anxiety the doctor asks the person about
BDD is an anxiety disorder that can disorder (GAD, p.52). BDD may their symptoms and how they
have a huge impact on daily life. be due to brain chemistry or affect them and may refer them
An individual with BDD worries genetics, and past experiences to a mental health specialist for
obsessively about how they look. may play a role in triggering its further treatment.
They often focus on a specific
aspect of their body, for example, Breaking the cycle
viewing a barely visible scar as a
major flaw or seeing their nose as Treatment for BDD can be highly successful and focuses on breaking the
abnormal, and are convinced that cycle of thoughts, feelings, and behaviors that maintain it. The length of
others view the “flaw” in the same time treatment takes depends on the severity of the condition.
way. The person may spend a great
deal of time concealing an aspect of EFFORTS TO CHANGE TRIGGER
their appearance, seeking medical APPEARANCE Seeing their reflection,
treatment for the part of the body Safety behaviors or misinterpreting body
believed to be defective, and/or diet social avoidance prevail. language, or someone’s
or exercise excessively. The person may apply passing comment can
excessive makeup or use start the cycle.
BDD affects about 1 in every 50 clothing to conceal the
people in the US, can occur in all perceived defective Negative AUTOMATIC
age groups, and is seen in males attribute; seek cosmetic self-image THOUGHTS
and females in equal numbers. It surgery; use extreme Negative thoughts
is more common in people with a diet and exercise to dominate, for
history of depression (pp.38–39) change body shape; and example, “I am
or social anxiety disorder (p.53), avoid social situations, defective and
thus increasing feelings defective people
TREATMENT of isolation. are worthless, so
I am worthless.”
❯❯Cognitive behavioral therapy
(p.125) to identify self-appraisal LOW MOOD
related to the problem body part The perceived constant
and weaken the beliefs that social threat leads to
maintain it. chronic anxiety and
depression.
❯❯Antidepressants and anti-
anxiety medication (pp.142–143)
alongside therapy.

Skin-picking and
hair-pulling disorders

Also known as excoriation and trichotillomania respectively,
these are impulse-control disorders in which a person has recurrent,
irresistible urges to pick at their skin or pull out their body hair.

What are they? conditions can also be associated individuals. They may avoid routine
with OCD (pp.56–57). activities or work, have difficulty
The expressed aim of skin pickers concentrating, become socially
or hair pullers is to achieve perfect Skin picking and hair pulling isolated, and suffer financial strain.
hair or skin, but the reverse is the often begin as a reaction to an
result. Both behaviors can cause immediate stress or may be a TREATMENT
physical damage. response to a traumatic experience
or abuse. The behavior can be ❯❯Behavioral therapies to
A person with trichotillomania learned from other members of the promote healthy stress
may pull hair from their scalp and/ family with similar habits or management. Habit reversal
or other parts of their body such as develop by chance and become training, combining awareness
eyebrows, eyelashes, and legs (and associated with stress relief, with alternative behavior, and
sometimes also from pets), which which is a powerful behavioral stimulus control using a different
can result in noticeable hair loss. reinforcement. Females are more activity while an urge dissipates.
They may also swallow the hair, likely to be affected, and symptoms
which can cause vomiting, stomach often start in girls aged 11–13 years. ❯❯Antidepressants (pp.142−143)
pain, and bleeding that can lead to prescribed along with therapy.
anemia. Skin picking can result in Hair pulling or skin picking can
scabs, abrasions, and lesions that cause significant impairment or
may become infected. Both of these disruption in daily life for affected

Repetitive Anxiety causes urge
behavior to pick/pull
PORARY R
Habits associated
Anxiety causes urge
with these disorders HAIR PULLING to pick/pull HAIR PULLING Social
often begin as Bald patches; isolation
hair balls; vomiting; Disruption to
a response to Pulls; tears; ELIEF stomach pain daily routine
stress or anxiety chews Anxiety and low
but become Blemishes; abrasions; self-esteem
TEM lesions; infections; Guilt and
addictive—the scarring
SKIN PICKING shame
more that a Picks; scratches;
squeezes; gouges
person pulls or

picks, the greater

their urge to do it, SKIN PICKING
in spite of the various

negative consequences.

Desire for
blemish-free skin or a

full head of hair

Illness anxiety 60 61
disorder

Previously known as hypochondria, this condition involves a person
worrying excessively about becoming seriously ill, even if thorough
medical examinations reveal nothing.

What is it? Someone who is anxious or TREATMENT
depressed is more prone to the
Hypochondria is considered to be disorder. Assessment and ❯❯Behavioral therapies such as
two separate conditions: illness treatment focus on stopping attention training to keep from
anxiety disorder if there are no avoidance and reassurance overattending to body sensations
symptoms or they are mild, or behaviors (below), reevaluating and help reevaluate beliefs.
somatic symptom disorder (pp.108− health beliefs, and increasing the
109) if there are major physical person’s tolerance of uncertainties. ❯❯Antidepressants (pp.142−143)
symptoms causing emotional stress. prescribed along with therapy.
People with illness anxiety disorder
become excessively preoccupied TEMPORARY RELIEF PAIN/SENSATION TRIGGER
with their health. Some have
exaggerated feelings about an FAMI LY caSntcoemr!ach M ISINTERPRET SIGNS
existing condition (about 20 percent
do have heart, respiratory, REASSURA .N..CFE .R..OM VICIOUS CYCLE OF
gastrointestinal, or neurological
problems). Others experience SEEK
unexplained symptoms. They
convince themselves that CONSTANTLY ILLNESS ANXIETY RESEARCH ILLNESS
these symptoms indicate a FROM DOCTOR
serious illness that has been
missed by medical teams.

Illness anxiety is a
long-term condition that
fluctuates in severity and
may worsen with age or
stress. It can be triggered
by a major life event.

...

Endless checks POSSIBLE AVOIDANCE CHECK BODY FREQUENTLY

Disbelief in medical opinion reaffirms
the person’s anxiety and results in
extra focus on the body part or illness,
which causes panic and physical
symptoms. Safety behaviors, such
as avoiding situations for fear of
exposure to disease, and reassurance
from others provide brief respite.

PTSD (post-traumatic
stress disorder)

This is a severe anxiety disorder that may develop anytime after
a person experiences or witnesses a terrifying or life-threatening
event, or series of events, over which they have little or no control.

What is it? including panic attacks, involuntary TREATMENT
flashbacks, nightmares, avoidance
PTSD is seen in people who have and emotional numbing, anger, ❯❯Trauma-focused therapy such
been in military combat or a serious jumpiness, insomnia, and difficulty as cognitive behavioral therapy
incident, or suffered prolonged concentrating. These symptoms (p.125) or eye movement
abuse or the unexpected injury or usually develop within a month of desensitization and reprocessing
death of a family member. The the event (but may not appear for (p.136) to help reduce the sense
event itself activates the fight-or- months or years) and last for more of current threat by working on
flight reflex in the brain and body, than three months. PTSD can lead memory of the event.
putting the person on hyperalert to to other mental health problems,
deal with the consequences of the and excessive alcohol and drug use ❯❯Compassion-focused therapy
trauma and protect them from a is common. to self-soothe from shame-based
repeat of the episode. An individual thoughts and images. Group
with PTSD feels that the threat Watchful waiting is advisable at therapy for vulnerable groups
remains, so their heightened first to see if the symptoms subside such as war veterans.
response is maintained, causing an within three months as treatment
array of unpleasant symptoms too early can exacerbate PTSD.

Brain changes PREFRONTAL CORTEX
Trauma affects the function of
PTSD is a survival reaction. the prefrontal cortex, changing
The symptoms result from an behaviors, personality, and complex
aim to help survive further cognitive functions such as planning
traumatic experiences, and and decision-making.
include raised levels of HYPOTHALAMUS
stress hormones and other In PTSD, the hypothalamus sends
changes in the brain. signals to the adrenal glands (on the
kidneys) to release the hormone
HIPPOCAMPUS adrenaline into the bloodstream and
PTSD increases stress increase the chances of survival.
hormones, which AMYGDALA
reduce activity in the PTSD increases the function of the
hippocampus and make amygdala, activating the fight-or-
it less effective in memory flight response and increasing
consolidation. Both the sensory awareness.
body and mind remain
hyperalert because the
decision-making ability
is reduced.

ASR (acute 62 63
stress reaction)

Also called acute stress disorder, ASR can appear quickly after
an exceptional physical or mental stressor such as a bereavement,
a road traffic incident, or an assault, but does not usually last long.

What is it? Symptoms of ASR can begin within TREATMENT
hours of the stress and are resolved
Symptoms of ASR are anxiety and within a month; if they last longer ❯❯Psychotherapies such as
dissociative behavior following they may turn into PTSD (opposite). cognitive behavioral therapy
exposure to a traumatic and (p.125) to identify and reevaluate
unexpected life event. The person ASR may resolve without therapy. thoughts and behaviors that
may feel disconnected from Talking things over with friends or maintain anxiety and low mood.
themselves, have difficulty relatives can help those with the
handling emotions, suffer mood disorder understand the event and ❯❯Lifestyle management including
swings, become depressed and put it into context. Individuals may supportive listening and stress-
anxious, and have panic attacks. benefit from psychotherapies, too. relieving practices such as yoga
They often experience difficulty or meditation.
sleeping, poor concentration, and 80%
recurrent dreams and flashbacks, ❯❯Beta-blockers and
and may avoid situations that of people with antidepressants (pp.142–143)
trigger memories of the event. ASR develop to ease physical symptoms in
Some individuals have PTSD 6 months combination with psychotherapy.
physiological symptoms such as later
raised heart rate, breathlessness,
excessive sweating, headaches,
chest pain, and nausea.

ASR is described as acute
because the symptoms come on
fast, but do not usually last.

HOW DOES ASR DIFFER FROM PTSD?

ASR and PTSD are similar, but the the symptoms are. However, in ASR REGULAR MEDITATION can benefit
time frames are different. The symptoms involving feelings, such as the relationship that those with ASR
symptoms of ASR occur within a dissociation, depression, and anxiety, have with uncomfortable mental
month of an event and they usually predominate. With PTSD the experiences and calm the fight-or-
resolve within the same month. The symptoms relate to a prolonged or flight response.
symptoms of PTSD may or may not persistent response to the fight-or-
develop within a month of the event flight mechanism (pp.32–33). There is
or events. PTSD is not diagnosed a higher risk of ASR developing in a
unless the symptoms have been person who has had PTSD or mental
evident for more than three months. health issues in the past, and ASR
There is an overlap between what can lead to PTSD.

Adjustment disorder

This is a short-term, stress-related psychological disorder that can
follow a significant life event. Typically, a person’s reaction is
stronger, or more prolonged, than expected for the type of event.

What is it? because the stress trigger is not as TREATMENT
severe. It normally resolves within
Any stressful event can trigger months as a person learns how to ❯❯Psychotherapies such as
anxiety, difficulty sleeping, sadness, adapt to a situation and/or the cognitive behavioral therapy
tension, and inability to focus. stressor is removed. There is no (p.125) and/or family or group
However, if an individual finds an way to predict whether one person therapies (pp.138−141) to help
event especially hard, their reaction is more likely to develop adjustment identify and respond to stressors.
can be stronger and persist for disorder than another. It comes
months. In a child, the disorder can down to how they respond to an ❯❯Antidepressants (pp.142–143)
follow family conflicts, problems at event and their personal history. to lessen symptoms of depression,
school, and hospitalization. The anxiety, and insomnia, along with
child may become withdrawn A GP initially assesses whether a psychotherapy.
and/or disruptive, and complain an individual’s symptoms may
of unexplained pain or illness. be due to another condition, such
Adjustment disorder is not the as ASR, before referring them
same as PTSD or ASR (pp.62–63) for a psychological assessment.

DEATH Causes and outcome

Some life events are known to lead to adjustment difficulties of varying severity.
Examples are the death of a friend or family member, divorce or relationship
breakdown, moving, illness or injury, financial worries, or job stress.

SOLD MOVING SYMPTOMS BEGIN SYMPTOMS
WITHIN 3 MONTHS RESOLVE IN
INJURY 3 MONTHS 3 MONTHS 6 MONTHS
The onset can be WITH HELP With therapy and
traced to an event removal of the
and symptoms are stressor, a person
more severe than can learn to turn
negative thoughts
expected. They into healthy actions
include defiant, to change how they
impulsive behavior; respond to stress.
sleeplessness; crying;
JOB STRESS feeling sad and
hopeless; anxiety;
and muscle tension.

DIVORCE

Reactive 64 65

attachment disorder

This disorder can result in children who do not bond with a
caregiver in infancy. Unidentified reactive attachment disorder
can be a precursor to lifelong impaired personal development.

What is it? Long-term impact TREATMENT

Attachment theory (pp.154–157) Early neutral, negative, or even

states that developing a strong hostile environments are likely to ❯❯Cognitive and behavioral
emotional and physical bond with a have a long-term negative impact therapies including cognitive
primary caregiver is key to a child’s and affect a person right through behavioral therapy (p.125) to
healthy personal development. to adulthood. An individual’s examine habitual appraisals,

Without such a bond a child can ability to make and maintain dialectical behavior therapy

become increasingly detached, healthy relationships in later life (p.126) to help severely affected
withdrawn, and distressed, and is seriously compromised. Reactive adults, family therapy (pp.138−141)
the physical symptoms relating attachment disorder can develop in to promote good communication,
to stress become obvious. early infancy, and the vulnerability anxiety management, and positive
it creates is associated with a wide behavior support.
Persistent disregard of a child’s

basic physical needs, frequent range of disorders that affect both

changes of primary caregivers, and children and adults (below).

childhood abuse can disrupt a

child’s ability to form social and

emotional bonds. The child can LEARNING
DIFFICULTIES
develop markedly disturbed ADULTTDbhEeisPcwacRcduaiaEotnsithSsnetoSdasrarItceeeOdabhvapxneaeeNcmeprtnlttroeiwedsdsvcpenoieesrtetnpeeasntaaialroiitntyy. Social isolation sceaolclfnaa-ritnepnnpeisfLonerraatO,esetgnfwiedfeWWatceriomhtvyaciimi,evctStc.hnetEhriioeneoLouucaFnnittt-spereEaasrinnSolardTyecfulEoaalttrlEihmoMionnimotshcdhdheei.iaapiflflndsitcihhNinunyoogltoaftuttddoRtlaemEIcvSLhaeSAkmloUeTpesIEOniSntNgs SHIP
ways of relating socially, creates a hostile
and may be unable to environment that
initiate or respond can make an
to social interactions. individual more
likely to have
Disinhibited responses, developmental
such as a disregard for
convention and impulsive disorders.
behavior, used to be included

in the assessment of this disorder, dDIfiIfSaFfpeOFpreICebeCeanIrerUsAnsstuod,LdLfsitirTnsschoaIoreferEmubelepySapeuttmtcltilihsblioayvoelnneiernireotgor.

but these are now considered as a

separate diagnosis of disinhibited

social engagement disorder. CHILD

Associated disorders SUBSTANCE
ABUSE
Undiagnosed reactive attachment disorder is an
underlying factor in a number of psychological Individuals who
problems that emerge in childhood or adulthood have suffered a
under clinical assessment. disrupted infancy
or childhood

commonly
seek support
through drugs.

ADHD (attention deficit
hyperactivity disorder)

This neurodevelopmental disorder is diagnosed in children with behavioral
symptoms (inattentiveness, hyperactivity, and impulsivity) that are
inconsistent with their age.

What is it? HYPERACTIVITY

This is a condition that makes it difficult for a child ❯❯Difficulties sitting still The child cannot
to sit still and concentrate, and it is usually noticeable stay seated (or quiet) in situations where it
before the age of six. The effects of ADHD can persist is expected, such as the classroom.
into adolescence and adulthood. Adults may also be
diagnosed with the preexisting condition, when ❯❯Constant fidgeting The child may twitch
persistent problems in higher education, employment, limbs, torso, and/or head, whether sitting
and relationships reveal it. However, the symptoms or standing.
may not be as clear as they are in children (right). The
level of hyperactivity decreases in adults with ADHD, ❯❯Lack of volume control The child shouts
but they struggle more with paying attention, and makes loud noises during normal
impulsive behavior, and restlessness. everyday activities.

The evidence for what causes ADHD is inconclusive, ❯❯Little or no sense of danger This may
but it is thought to include a combination of factors. result in the child running and climbing in
Genetics may play a part, which explains why it runs environments where these behaviors are
in families. Observations of brain scans also indicate neither safe nor appropriate.
differences in brain structure, and have identified
unusual levels of the neurotransmitters dopamine and
norepinephrine (pp.28–29). Other possible risk factors
include premature birth, low birthweight, and
exposure to environmental hazards. The condition is
more common in people with learning difficulties.
Children with ADHD may also display signs of other
conditions such as ASD (pp.68–69), tic disorders or
Tourette's (pp.100–101), depression (pp.38–39), and
sleep disorders (pp.98–99). Surveys have shown that
worldwide this condition affects more than twice as
many boys as girls.

Identifying ADHD

A GP cannot officially diagnose ADHD, but if they suspect
a child has the disorder they refer them for specialist
assessment. The child’s patterns of hyperactivity,
inattention, and impulsive behavior are observed over
a six-month period before a treatment plan is prepared.

PSYCHOLOGICAL DISORDERS 66 67
ADHD (attention deficit hyperactivity disorder)

“… an ADHD brain [is] like TREATMENT
a browser with way too
many open tabs.” ❯❯Behavioral therapies (pp.122–129)
to help the child and their family
Pat Noue, ADHD Collective manage day to day; psychoeducation
(p.113) for families and caregivers.
INATTENTIVENESS
❯❯Lifestyle management such as
❯❯Concentration difficulties This causes the child to improving physical health and
make errors of judgment and mistakes. Along with reducing stress to calm the child.
constant movement, this can cause injury.
❯❯Medication can calm (not cure)
❯❯Clumsiness The child is prone to dropping and the person so that they are less
breaking things. impulsive and hyperactive.
Stimulants (pp.142–143) increase
❯❯Easily distracted The child appears not to be listening dopamine levels and trigger the
and is unable to complete tasks. area of the brain involved in
concentration.
❯❯Poor organizational skills The child’s inability to
concentrate has an impact on organizational abilities. MANAGING
ADHD
❯❯Forgetfulness This results in the child losing things.
There are a number of ways that
IMPULSIVITY parents can help their child to handle
the condition.
❯❯Interrupting The child disrupts conversations
regardless of the speaker or situation. ❯❯Create predictable routines to
calm an ADHD sufferer. Schedule
❯❯Inability to take turns The child is unable to daily activities and keep them
wait their turn in conversations and games. consistent. Make sure school
timetables are clearly set, too.
❯❯Excessive talking The child may change a topic
often or focus obsessively on one. ❯❯Set clear boundaries and make
sure the child knows what is
❯❯Acting without thinking The child is unable expected of them; praise positive
to wait in line or keep up with group pace. behavior right away.

❯❯Give clear instructions, either visual
or verbal, whichever the child finds
easier to follow.

❯❯Use an incentive scheme, for
example, have a star/points chart
whereby a child can earn privileges
for good behavior.

ASD (autism
spectrum disorder)

ASD describes a spectrum (range) of lifelong disorders that affect
a person’s ability to relate to other people—and their emotions and
feelings—making social interaction difficult.

What is it? Genetic predisposition, premature birth, fetal alcohol
syndrome, and conditions such as muscular dystrophy,
ASD is generally diagnosed in childhood and can Down syndrome, and cerebral palsy are known to be
present in a variety of ways. A parent or caregiver associated with ASD. A GP first examines the child
may notice that a baby does not use vocal sounds or to rule out physical causes for the symptoms, then
an older child has problems with social interaction refers them for specialist diagnosis. Information is
and nonverbal communication. Symptoms such as gathered about all aspects of the child’s behavior
repetitive behaviors, problems talking, poor eye and development, at home and school. There is no
contact, tidying or ordering rituals, bizarre motor cure, but specialized therapies such as speech
responses, repetition of words or sentences, a therapy and physical therapy can help. One in every
restricted repertoire of interests, and sleep problems 68 people in the US has ASD and it is identified in
are common. Some children with ASD may also have more girls than boys.
depression (pp.38–39) or ADHD (pp.66–67).

Communication Social Repetitive
interaction behavior
Problems with language
are common. Some people Impaired social skills Repetitive behavior traits
with ASD are fluent, while mean that a person with are common. An individual
others are speech impaired. ASD cannot recognize may make repetitive
All tend to be literal and another’s personal space or movements such as hand
have difficulty with read body language. The flapping or rocking, or
understanding humor, person might think out loud develop rituals such as
context, and inference. or repeat what another lining up certain toys or
person has said. flicking switches on and off.

PSYCHOLOGICAL DISORDERS 68 69
ASD (autism spectrum disorder)

HIGH-FUNCTIONING AUTISM AND ASPERGER’S TREATMENT

High-functioning autism (HFA) and share of perfectionism and obsessive ❯❯Specialist interventions
Asperger’s syndrome (AS) are both interest in a specific subject can mean and therapies can assist with
terms that are applied to people with that they become experts in their area self-harming, hyperactivity,
characteristics of ASD, but who are of of interest. Like ASD, those with HFA and sleep difficulties.
above average intelligence with an IQ or AS also require strict routines and
of more than 70. However, they exist have sensitivities to certain stimuli, ❯❯Educational and behavioral
as two separate diagnoses, as those awkwardness, and difficulty behaving programs can support the
with HFA have delayed language appropriately and communicating in learning of social skills.
development, which is not present in social situations; the severity of these
AS. Diagnosis of HFA or AS may be symptoms will differ in each ❯❯Medication (pp.142−143) can
missed in children as they are socially individual. Long-term difficulties arise help with associated symptoms—
awkward with a manner that is not with social and intimate relationships, melatonin for sleep problems,
easily understood. The ASD traits they both at school and into adulthood. SSRIs for depression, and
methylphenidate for ADHD.

Degrees of ASD “… in science or art, a dash
of autism is essential.”
ASD manifests itself in different ways and to different
degrees in each person. Autistic author and academic Hans Asperger, Austrian pediatrician and researcher of autism
Stephen M. Shore said, “If you’ve met one individual
with autism, you’ve met one individual with autism.”

Sensory Motor Perception
skills skills
Impaired sensory and
Heightened sensitivity Difficulties with visual perception means
to sound can cause a movement, such as that those with ASD miss
person to develop coordination and motor nonverbal cues, can be
avoidance behaviors planning, are common in unaware of lies, and usually
such as humming, covering children with ASD. Fine have difficulty seeing a
their ears, or self-isolation motor skills like handwriting situation from another
in a preferred space to may also be affected, which person’s perspective.
escape noise. can hinder communication.

Schizophrenia

This is a long-term condition that affects the way a person thinks.
It is characterized by feelings of paranoia, hallucinations, and
delusions, and significantly impacts a person’s ability to function.

What is it? Popular theories regarding the causes of schizophrenia
in the second half of the 20th century included family
The word schizophrenia comes from the Greek, and dysfunction theories, such as the “double bind” (when
literally means “split mind,” which has led to the myth people are faced with contradictory, irreconcilable
that people with the condition have split personalities, demands for courses of action), high levels of parent/
but they do not. Instead they suffer from delusions and caregiver “expressed emotion” (not tolerating those
hallucinations that they believe are real. There are with the disorder), and learning the schizophrenic role
different types of schizophrenia. The main ones are through labeling. Since then, mental health specialists
paranoid (hallucinations and delusions); catatonic have observed that hearing voices or feeling paranoid
(unusual movements, switching between being very are common reactions to trauma, abuse, or deprivation.
active and being very still); and disorganized, which Stress can trigger acute schizophrenic episodes, and
has aspects of both. Despite popular belief, individuals learning to recognize their onset can help with
with schizophrenia are not always violent. They are, management of the condition.
however, more likely to abuse alcohol and drugs, and it
is these habits, combined with their condition, that can Positive symptoms (psychotic)
cause them to become aggressive.
These symptoms are classed as positive because they are
Schizophrenia appears to result from a combination additions to a person’s mental state and represent new
of physical, genetic, psychological, and environmental ways of thinking and behaving that only develop with
factors. MRI scans have identified abnormal levels of the condition.
neurotransmitters dopamine and serotonin (pp.28−29)
and unusual brain structure, and there might be a ❯❯Hearing voices is common, and can occur
correlation between the condition and pregnancy or occasionally or all the time. The voices
birth complications. It is also thought that excessive may be noisy or quiet, disturbing or negative,
cannabis use in young adulthood can be a trigger. known or unknown, and male or female.

TREATMENT ❯❯Hallucinations involve seeing things that are
not there but seem very real to the person,
❯❯Community mental health teams such as social and are often violent and very disturbing.
workers, occupational therapists, pharmacists,
psychologists, and psychiatrists work together to ❯❯Feeling sensations can cause a person to be
develop ways to help a person stay stable and progress. convinced that they have unpleasant creatures
such as ants crawling on or under their skin.
❯❯Medication in the form of antipsychotics (pp.142−143) is
prescribed to reduce mostly positive symptoms, but it ❯❯Smelling and tasting things that cannot be
does not cure the condition. identified can arise, and there may be difficulty
discriminating between smells and tastes.
❯❯Cognitive behavioral therapy (p.125) and the
technique of reality testing can help with management ❯❯Delusions—fixed beliefs—are held despite
of symptoms such as delusions. New developments use evidence to the contrary. The person may
imagery to defuse stress that negative symptoms cause. think they are famous and/or being chased
or plotted against.
❯❯Family therapy (pp.138−141) can improve relationships
and coping skills within the family and educate anyone ❯❯Feelings of being controlled by, for
involved in a person’s care. example, a religious or dictatorial delusionist,
can overwhelm a person. The beliefs can make
them act differently.

PSYCHOLOGICAL DISORDERS 70 71
Schizophrenia

How is it diagnosed? social, and work life to build up. While schizophrenia
is not curable, people can overcome it enough to
Schizophrenia is diagnosed through clinical interviews function day to day. A personalized treatment plan
and specialist checklists during which the symptoms that caters to the specific needs of the individual with
(below) are assessed. The earlier the condition is schizophrenia is required for people with such a
diagnosed and treatment begun, the better, so that complex mental health issue.
there is less time for its extreme impact on personal,

1.1%Around Negative symptoms (withdrawal)

of the global adult These symptoms are called negative because they
population has represent a loss of certain functions, thoughts, or
schizophrenia behaviors that a healthy person exhibits, but that
are absent in those with schizophrenia.

❯❯Difficulty communicating with others
can result in changed body language, a lack
of eye contact, and incoherence.

❯❯“Flattened” emotions result in a significantly
reduced range of response. The person will
take no pleasure in activities.

❯❯Tiredness may result in lethargy, change in
sleep patterns, staying in bed, or sitting in the
same place for long periods.

❯❯Absence of willpower or motivation makes
it difficult or even impossible for a person to
engage in normal day-to-day activity.

❯❯Poor memory and concentration means
that the individual is unable to plan or set
goals and has difficulty keeping track of
thoughts and conversations.

❯❯Inability to cope with everyday tasks results
in disorganization. The individual stops looking
after themselves, domestically or personally.

❯❯Becoming withdrawn from social and
community activities can disrupt the
individual’s social life.

Symptoms of schizophrenia

These are classified as positive or negative. Positive
symptoms are psychotic additions to an individual,
whereas negative symptoms can look like the withdrawal
or flat emotions seen with depression. Schizophrenia is
likely if a person has experienced one or more symptoms
from both domains for most of the time for a month.

Schizoaffective
disorder

This is a long-term mental health condition in which a person suffers
both the psychotic symptoms of schizophrenia and the deregulated
emotions that characterize bipolar disorder at the same time.

What is it? made it possible to develop coping TREATMENT
skills. Genetics may play a part, too.
While symptoms may vary from It is more common in women and ❯❯Medication is needed long-term;
person to person, one episode will usually begins in early adulthood. usually combinations of mood
feature both psychotic and mood stabilizers plus antidepressants for
symptoms (manic, depressive, or A mental health professional will depressive types or antipsychotics
both) for part of the time and a assess the symptoms and will want for manic types (pp.142−143).
period with only psychotic or mood to know how long they have been
symptoms for most of the time over present, and what triggers them. ❯❯Cognitive behavioral therapy
a period of at least two weeks. This chronic condition impacts (p.125) can help a person make
every aspect of a person’s life, but links between thoughts, feelings,
Schizoaffective disorder can be symptoms can be managed. Family and actions; learn the cues
triggered by traumatic events that interventions to raise awareness preceding behavior change;
took place when a person was too of the disorder can improve sand develop coping strategies.
young to know how to cope or was communication and support.
not being cared for in a way that

The different forms 1% of the population is likely

People with this disorder experience to develop schizoaffective disorder
periods of psychotic symptoms—such
as hallucinations or delusions—with Mood disorder symptoms
mood disorder symptoms of either
a manic type or a depressive type, Manic type Depressive type Mixed type
but sometimes both. The condition is hyperactive, feels feels sad, empty, has symptoms of
features cycles of severe symptoms high, cannot sleep, and worthless, both depression
followed by periods of improvement.
and takes risks. even suicidal. and mania.
Psychotic symptoms

❯❯Hallucinations Hearing
voices and seeing things that
are not there.

❯❯Delusions False, fixed beliefs
in things that are not true.

Catatonia 72 73

An episodic condition that affects both behavior and motor skills,
catatonia is characterized by abnormal psychomotor functioning
and extreme unresponsiveness when awake.

What is it? Mutism
Silent and apparently
Catatonia is a state of immobility that can persist unwilling or unable
for days or weeks. Those with the condition may have
an extremely negative outlook and may not respond to speak.
to external events, become agitated, have difficulty
speaking due to extreme anxiety, and refuse to eat Echolalia Grimacing Stupor
or drink. Symptoms also include feelings of sadness, Constantly Makes Immobile,
irritability, and worthlessness, which can occur nearly lacks
every day. An individual may lose interest in activities, repeats distorted facial expression,
lose or gain weight suddenly, have trouble getting to what expressions and does
sleep or out of bed, and feel restless. Decision making other that show not respond
is impaired and suicidal thoughts are common. to stimuli.
people disgust, dislike,
This condition can have a psychological or have said. and even pain.
neurological cause, and may be associated with
depression (pp.38–39) or psychotic disorders. It is
estimated that 10−15 percent of people with catatonia
also have symptoms of schizophrenia (pp.70–71),
while about 20−30 percent of individuals with bipolar
disorder (pp.40–41) may experience catatonia during
their illness—mostly during their manic phase.

Diagnosing catatonia Catalepsy May be rigid, have
a seizure, or be completely
A mental health professional observes an individual unresponsive in this
and looks for a number of symptoms. At least 3 trancelike state.
out of the 12 symptoms described (right) must be
present to confirm a diagnosis of catatonia. Waxy flexibility Limbs can be
moved by someone else and will
TREATMENT
remain in the new position.
❯❯Medication prescribed depends on the symptoms,
but includes antidepressants, muscle relaxers, Agitation Mannerism Posturing
antipsychotics, and/or tranquilizers such as Movement Strikes poses Moves from
benzodiazepines, but these carry a risk of dependency one unusual
(pp.142−143). Outside help is needed to ensure may be or makes position to
compliance with medication and to teach living skills. purposeless idiosyncratic another.
movements.
❯❯Electroconvulsive therapy may be used when and risky.
medication is ineffective. This involves transmitting an
electric current through the person’s brain (pp.142−143). Stereotypy Negativism Echopraxia
Frequent Resistant to Constantly
any outlook mimics other
persistent, other than a people’s
repetitive negative one. movements.
movements.

Delusional disorder

This is a very rare form of psychosis that causes a person to
experience complex and often disturbed thoughts and delusions
that are not true or based on reality.

What is it? Delusional disorder can make it hard for a person to
concentrate, socialize, and live a normal life, because it
Previously known as paranoid disorder, delusional can cause dramatic changes in a person’s behavior that
disorder is marked by an individual’s inability to result in conflict with those around them. Individuals
distinguish what is real from what is imagined. The may become so preoccupied with their delusions that
delusions may be misinterpretations of experienced their lives are disrupted. However, others continue
events, and are either not true or highly exaggerated. to function normally and, apart from the subject of
They may be nonbizarre and relate to situations that their delusion, do not behave in an obviously odd
could occur, such as being followed, poisoned, manner. Some people experience hallucinations—
deceived, or loved from a distance, or may be bizarre seeing, hearing, tasting, smelling, or feeling things
delusions that are impossible, for example, a belief that are not really there.
in an imminent alien invasion.

Thematic delusions Erotomanic
A delusion in which a person
Delusions are fixed beliefs that do not change, even when believes that another individual,
a person is presented with conflicting evidence, and often someone famous, is in love
characteristically follow particular themes (right). Individuals
are likely to display the delusion for a month or longer, and with them; may lead to
most do not admit they are problematic. The person may stalking behavior.
appear completely normal as long as an outsider
does not touch on the belief.

Somatic Grandiose
A person with these An individual with grandiose
delusions believes they have a
delusions has great unrecognized talent or
physical or bodily knowledge, for example, they
may be a special messenger,
sensations—for
example, as a guru, or God.
result of believing
insects are crawling
under their skin.

PSYCHOLOGICAL DISORDERS 74 75
Delusional disorder

Psychological disorders known to trigger delusional TREATMENT
episodes include schizophrenia (pp.70−71), bipolar
disorder (pp.40−41), severe depression (pp.38−39) or ❯❯Medication (pp.142−143) prescribed may include
stress, and lack of sleep. General medical conditions antipsychotic drugs to reduce the delusional symptoms
that can cause them are HIV, malaria, syphilis, lupus, and antidepressants such as selective serotonin reuptake
Parkinson’s, multiple sclerosis, and brain tumors. inhibitors (SSRIs) to help with the depression that can
Misuse of substances such as alcohol or drugs can be associated with the disorder.
also trigger delusional episodes in some people.
❯❯Psychotherapies such as cognitive behavioral therapy
How is it diagnosed? (p.125) to help examine the strongly held beliefs and
support changes needed.
A doctor will first take a complete medical history of
the individual. They will ask about symptoms and ❯❯Self-help groups and social support to reduce the
will want to know how a delusion affects a person’s stress that results from living with this disorder and
day-to-day functioning, any family history of mental to help those around them, and family, social, and/or
health conditions, and details of medications and/or school intervention to help develop social skills to
illegal substances a person has been taking. reduce the impact of the disorder on quality of life.

Persecutory 0.2%Only of people
A person with these will ever experience delusions
delusions feels that they
are being persecuted or
mistreated—for example,
stalked, drugged, spied
on, or the victim of

slander.

Jealous Mixed or unspecified
People with this delusion have a Themes are said to be mixed
morbid but unfounded belief that if several types of delusions are
their partner has been unfaithful present but no particular one
predominates. In some cases the
or is deceiving them. delusion does not fall into any
of the main categories and

is unspecified.

Dementia

This is an (as yet) incurable, degenerative disorder, also known as
mild or major neurocognitive impairment. It is characterized by
memory disorders, personality changes, and impaired reasoning.

What is it? Dementia is mainly seen in older cdofaonbmItrrfMramtoaihnogloeeltervodaeserr,ssmepmesanokeussnnisl.otslcsifalbetrlheee
adults, but can occur in people in EImneacoxbapatiunirloiesdtnesysdsltoefoepwecrloesinesnsgltfirs-ooecnlsa.tonerem
The term dementia describes a set their 50s (known as early onset),
of symptoms that affect the brain and sometimes even younger.
and gradually become more severe.
Symptoms include difficulties with There is no single assessment for
concentration, problem solving, dementia. The GP uses memory
carrying out a sequence of tasks, and thinking tests and may order
planning, or organizing, as well as a scan to confirm which areas of
general confusion. the brain are damaged. Treatment
aims to alleviate symptoms and
A person with dementia may lose slow their progression.
track of days or dates, and find it
hard to follow a conversation or 30%More than
recall the right word for something.
They may also be unable to judge of people over
distances or see objects in three 65 develop
dimensions. Dementia may cause dementia
people to feel insecure and lose
their self-confidence and can result
in depression.

Many different conditions, such
as Alzheimer’s, cardiovascular
disease, Lewy bodies, and
disorders of the front and side lobes
of the brain, cause the symptoms.

CAUSES ❯❯Mixed dementia results when
Alzheimer’s and vascular dementia
❯❯Alzheimer’s disease causes occur at the same time.
abnormal proteins to build up
around brain cells and damage ❯❯Dementia with Lewy bodies has
their structure. This disrupts the similar symptoms to Alzheimer’s and
chemical messages that pass Parkinson’s disease. Also known as
between the cells so the cells Pick’s disease, it occurs when protein
gradually die. Symptoms progress as bodies form in nerve cells and often
more parts of the brain are affected. causes hallucinations and delusions.

❯❯Vascular dementia can result from ❯❯Frontotemporal dementia is a
cardiovascular disease. It occurs rarer form that affects the temporal
when blood flow to the brain is (side) and frontal lobes of the brain.
impaired (for example, by a stroke), It alters personality and behavior,
causing problems with reasoning, and makes use of language difficult.
planning, judgment, and memory.

SoTchcieoafonlicnlcslaaotkenobnwilimtrllrisectaaolyatknetteeovaeitntorddsapiftefiioocnpullet . parlloosisSognMhargfefoa-festeirselmtsce-rttmsaoee.srdrmtmyhfieermsmdte,iosbmreuyaotsrey 76 77

DMecceocimodnsoniecoorcefruninisymstimiorlopoannatosiskmosc,sianpnaibn,kogalimeonn.rgdakheard SSohpdpfaeielsraeacdnkoc,gihnwnucghaeiagrcntehidnbcgceaofcnoonbrmtreoel TREATMENT
CLmaloainvcandikknceigoendfnvdafeteorirlpcayyeutrdinsooidcfunfeaitcnninutelts. others.
❯❯Cognitive stimulation and
juloadcsngNosyJmnuoothtefdrlinofognatnlmgi.toghleeer nriaandftbeosleewtloitnnogpilnan reality orientation therapy
ESmstherlpuniatthgpastleigptenhleoikrnynoifngiwongtmghooalfmeftooaiarstvkheeesrs. for short-term memory.

❯❯Behavioral therapy (p.124) to
help carry out daily routines.

❯❯Validation therapy—the main
caregiver reading out loud,
respectful statements.

❯❯Cholinesterase inhibitors
(pp.142–143) to boost memory
and judgment.

How it affects
a person

Because every person is different, their
experience of dementia is, too. The
diagnosis is based on a person’s
history and how the symptoms affect
their ability to cope day to day.

PEOPLE WITH DEMENTIA feel insecure,
lose confidence in themselves, and need help
preparing for the road ahead.

CTE (chronic traumatic
encephalopathy)

Also known as post-concussion syndrome, this is a degenerative
condition of the brain characterized by physiological and
psychological disturbances following closed head injuries.

What is it? include headache, dizziness, and the head trauma. A preventive
pain. Psychological symptoms are approach is advisable, with the use
CTE is most often seen in service memory loss, confusion, impaired of protective headgear and the
personnel or people who take part judgment, impulse-control problems, introduction of rules that disallow
in high-impact contact sports, such and even hallucinations. An contact above chest or shoulder
as football, rugby, or boxing, and individual may become aggressive height in sport.
there is no cure. Physical symptoms and have difficulty maintaining
relationships. Signs of Parkinson’s At the moment it is possible to
TREATMENT and dementia (pp.76–77) can diagnose CTE only after death.
emerge later. The disturbances may Tests, brain scans, and biomarkers
❯❯Psychotherapies such as develop early, or emerge years after are being developed to help identify
cognitive behavioral therapy the condition earlier.
(p.125) and mindfulness-based
stress reduction (p.129). CTE was identified in 99% of former
US National Football League players
❯❯Lifestyle management including
rest and recuperation after initial Cumulative effect of head injury
head injury, followed by a gradual
return to activities, stopped if Multiple blows to the unprotected skull can lead to irreversible injury.
symptoms return. In a study of 100 people with mild head injury, 20–50 showed
symptoms of CTE three months after the initial injury, and about
❯❯Antidepressants (p.142–143) 1 in 10 still had problems a year later.
if psychological symptoms
warrant them.

1 2 3

A blow to a healthy brain The initial injury can leave a After three or more blows the
can cause concussion but a person vulnerability, so the brain is less brain is more susceptible to
able to recover from a second one. widespread, permanent damage.
is likely to recover completely.

Damage
arising from

first injury

Delirium (acute 78 79

confusional state)

This is an acutely disturbed state of mind characterized by lethargy,
restlessness, delusions, and incoherence, which can result from a
variety of causes including illness, poor diet, or intoxication.

What is it? chest or urinary tract infection, or a TREATMENT
metabolic imbalance, such as low
Delirium can have a serious impact sodium. Delirium can also follow ❯❯Reality orientation therapy,
on day-to-day life but is usually severe illness, surgery, pain, involving the use of repeated
short-term. An individual has dehydration, constipation, poor visual and verbal orientation cues
difficulty concentrating and may nutrition, or a change in medication. delivered in a respectful manner,
be confused as to where they are. to help the person understand
They may move more slowly or How is it diagnosed? their surroundings and situation.
quickly than usual and experience
mood swings. Other symptoms A doctor checks the symptoms ❯❯Lifestyle management including
include not thinking or speaking and assesses movement, cognitive routine and scheduled activity
clearly, difficulty sleeping or feeling processes, and speech. Some with exercise to minimize
drowsy, reduced short-term practitioners use observational confusion and help the individual
memory, and loss of muscle control. methods to diagnose or rule out regain some day-to-day control.
delirium, by watching the person’s
Delirium may occur at any age, behavior over an entire day. ❯❯Antibiotics prescribed if illness is
but it is more common in the elderly Physical tests may be carried out identified as the cause, together
and can be confused with dementia to check for underlying illness. with rehydration if necessary.
(pp.76–77). It is generally a short-
term physical or emotional problem, Hypoactive delirium Hyperactive delirium
but it can be irreversible. It is also
possible to have dementia and
delirium at the same time.

Causes vary, but likely reasons
are a medical condition, such as a

50%Up to The person is lethargic Mixed delirium The person is agitated,
and withdrawn, sleepy, An individual can have restless, and easily startled.
of elderly unmoving, and hardly reacts hyper- and hypoactive They may experience
patients in the to their environment. This delirium in the same day. hallucinations (seeing
hospital suffer type of delirium can easily The person may feel they things that are not there)
from delirium be mistaken for depression. are not in control and and delusions (believing
things that are not true).
have out-of-body
sensations.

Substance use
disorder

This is a serious condition in which the use of alcohol or drugs, or
both, leads to physical and psychological problems that affect the
individual’s working or home life for the worse.

What is it? cancers. Drugs can be associated with mental health
issues such as depression, schizophrenia (pp.70–71),
Also known as drug use disorder or substance abuse, and personality disorders (pp.102–107).
this condition can cause wide-ranging impairments
and psychological distress. Symptoms and signs of Alcohol or drug abuse usually begins as a voluntary
substance abuse (whether alcohol or drugs) include behavior, encouraged or tolerated within the person’s
taking drugs regularly, maybe daily, to function; taking social and cultural climate. Peer pressure, stress, and
drugs even when alone; continuing to use drugs even family dysfunction can escalate the problem. A child
when the person knows it is harming their own health, with a family member who has chemical-dependency
family, or work; making excuses to use drugs and issues may be at a higher risk of the disorder for either
reacting with aggression to inquiries about their environmental or genetic reasons or both.
substance use; being secretive about using drugs;
losing interest in other activities; impaired ability How is it diagnosed?
to work; neglecting to eat or attend to physical
appearance; confusion; lethargy; depression; financial Diagnosis begins with the person recognizing that
problems; and criminal activity such as stealing money. they have a problem; denial is a common symptom of
addiction. Empathy and respect are more likely to
In the longer term, overconsumption of alcohol can induce a person to accept that they have substance
cause weight gain and high blood pressure and use disorder than orders and confrontation. The GP or
increase the risk of depression (pp.38–39), liver specialist grades the person’s behavior (below) while
damage, problems with the immune system, and some the individual is using the substance.

TREATMENT Behavior patterns

❯❯Psychotherapies, such as cognitive behavioral therapy The diagnosis of this disorder, whatever the
(p.125) or acceptance and commitment therapy (p.126), substance, is based on a set of 11 behaviors
to look at the thinking and behaviors that maintain the related to its use. The severity of the disorder
addiction and change a person’s relationship with their is based on how many of these behaviors
thoughts. are present: 0–1 = no diagnosis; 2–3 = mild
substance use disorder; 4–5 = moderate
❯❯Psychosocial support through attending meetings substance use disorder; 6+ = severe
with peer groups, such as Alcoholics Anonymous, to substance use disorder.
motivate and encourage a person to stop substance
abuse and improve their quality of life.

❯❯Residential inpatient units in severe cases to limit
a person’s activities during detoxification and provide
medication necessary to help manage any extreme
withdrawal symptoms.

PSYCHOLOGICAL DISORDERS 80 81
Substance use disorder

Alcohol use

sUusbestoafnoctehser

Impaired control Social impairment Risky use Pharmacological criteria

❯❯1. Uses substance for ❯❯5. Continues to use ❯❯8. While under the ❯❯10. Becomes tolerant to
longer and/or in larger despite knowing the influence, engages the substance, so needs
amounts than originally problems it causes with in risky sexual behavior increasing amounts to
intended. life at home or work. or puts themselves or achieve the same effects.
others in danger, for Different drugs vary in
❯❯2. Wants to cut down, but ❯❯6. Continues to use example, by driving, terms of how quickly
cannot do so. despite arguments with operating machinery, tolerance develops.
family or the loss of or swimming.
❯❯3. Spends longer and friendships it causes. ❯❯11. Suffers withdrawal
longer getting, using, and ❯❯9. Continues to use while such as nausea, sweating,
recovering from using the ❯❯7. Gives up social and aware that the substance and shaking if the intake
substance. recreational activities as a is making psychological or is stopped.
result, so spends less time physical problems worse
❯❯4. Has intense cravings for with friends and family, (for example, drinking
the substance, which and becomes increasingly even when liver damage
makes it difficult for the isolated. has been diagnosed).
person to think about
anything else.

29.5million

people in the world have
drug use disorder

United Nations Office on Drugs and Crime, World Drug Report 2017

Impulse-control
and addiction

Impulse-control disorders are diagnosed in people who cannot
withstand the urge to perform problematic behaviors. In addiction, a
pleasurable activity becomes compulsive and interferes with daily life.

What are they? or arousal before the action, disorder (below). Sex, exercise,
pleasure or relief while doing it, shopping, and Internet addictions
The basic concepts underlying and regret or guilt in the aftermath. (below) share similar traits.
impulsive and addictive behaviors Environmental and neurological
overlap. Some psychologists think factors both play a part in the IMPULSIVE PLEASURE/
that impulse-control disorders development of the disorders and ACTS RELIEF
should be classed as addictions. they may be triggered by stress.
TENSION/ REGRET/
In impulse-control disorders, a The recognized impulse-control AROUSAL GUILT
person perpetuates their behavior disorders are compulsive gambling
regardless of the consequences, (opposite), kleptomania (p.84),
and they become less and less able pyromania (p.85), hair pulling
to control their inner urges. Usually, (p.60), and intermittent explosive
a person feels an increasing tension

Impulse-control disorders and addictions

DISORDER WHAT IS IT? TREATMENT

INTERMITTENT Tendency to short but violent Impulse-control training to
EXPLOSIVE outbursts even though there is no identify cues and change
DISORDER real trigger for the behavior. responses; adapt environment.

SEX Intense focus on sex and how Psychotherapies can support
ADDICTION to obtain it, regardless of the the development of alternative
negative impact on everyday life. emotional coping strategies.

EXERCISE Uncontrollable compulsion to Behavioral therapy to manage
ADDICTION exercise beyond health needs that stress with more adaptive
can result in injury or illness. activities and planned exercise.

SHOPPING Stress-triggered, irresistible urge Behavioral therapy to support
ADDICTION to shop, followed by euphoria that changes in thinking and
provides only temporary relief. responses to break the cycle.

COMPUTER/ Preoccupation that leads to more Behavioral therapy to become
INTERNET time spent online, and mood aware of problem and develop
ADDICTION problems if that time is restricted. ways to cope with real world.

Gambling disorder 82 83

Also known as compulsive gambling, this is an impulse-control
disorder that exists when a person repeatedly gambles despite the
significant problems or distress it causes themselves and others.

What is it? anxiety, depression, and suicidal do not admit they have a problem,

The thrill of winning releases thoughts. Physical signs can a major component of treatment is
dopamine (p.29) from the reward
center in the brain. For some people include sleep deprivation, weight helping them to acknowledge it.
the act of gambling becomes
addictive and they need ever bigger gain or loss, skin problems, ulcers, The true prevalence of the disorder
wins to achieve the same thrill.
bowel problems, headaches, and is not known because so many hide
Once a gambling disorder takes
hold, the cycle is difficult to break. muscle pains. Because most people their habit.
The disorder may start from
desperation for money, the need to 1% of the American population
experience the highs, the status are pathological gamblers
associated with success, and the
atmosphere of a gambling Thrill of winning
environment. The person can
become irritable if they attempt to DESIRE FOR SOCIAL DOPAMINE PLAYS AGAIN INCREASES
cut down, and then may gamble EASY MONEY STATUS OF RELEASED BY FOR MORE SIZE OF
because of the distress. Severe SUCCESS STAKES
disorders can take hold through a WINNING REWARDS
financial desperation to recoup lost
money. Even when the person
finally wins again, it is rarely
enough to cover losses. Aside from
significant financial loss, excessive
gambling can impact badly on
relationships. It can also cause

TREATMENT AFFECTS PHYSICAL DEPRESSION/
RELATIONSHIPS SYMPTOMS ANXIETY
❯❯Cognitive behavioral therapy SUFFERS
(p.125) to help people learn to INABILITY SUICIDAL
resist the beliefs and behaviors TO SLEEP THOUGHTS WITHDRAWAL
that maintain the disorder. STRUGGLES SYMPTOMS
WITH WORK LIES TO
❯❯Psychodynamic therapy (p.119) COVER EXTENT RETURNS TO TRY
to help grasp the meaning and OF PROBLEM TO RECOUP
consequences of the behavior. DEBT INCREASES LOSSES

❯❯Self-help groups and counseling
to help understand how the
behavior affects others.

Kleptomania

An individual with kleptomania has an irresistible and repeated
compulsion to steal items. These episodes of stealing occur
unexpectedly, without planning.

What is it? that most shoplifters plan the theft, 24 percent of those arrested
usually because they want an item for shoplifting are thought to suffer
A person with kleptomania steals but do not have enough money to from it. Kleptomania is associated
on impulse and often throws the buy it. with other psychiatric problems
stolen goods away, because they such as depression, bipolar disorder,
are mostly interested in the act Many people with kleptomania generalized anxiety disorder,
of stealing. Kleptomania is live secret lives of shame because eating and personality disorders,
distinguished from shoplifting in they are afraid to seek help; up to substance abuse, and other
impulse-control disorders. There is
Intrusive thoughts evidence to link kleptomania with
about stealing triggered. the neurotransmitter pathways
associated with behavioral
addictions and mood-enhancing
neurochemicals like serotonin.

There is no specific cure for
kleptomania, but psychotherapy
and/or medication may help break
the cycle of compulsive stealing.

Feelings of stress, Urge to steal Perpetual pattern
guilt, and self- is impossible
loathing arise. A person with kleptomania may
to resist. report feeling tense before they steal,
then pleased and gratified as they do
it. The subsequent guilt can increase
the tension again.

Arousal and relief STEALING TREATMENT
follow immediately
❯❯Psychotherapies such as
after the event. behavior modification, family
(pp.138−141), cognitive behavioral
Item is often not Item is usually hidden Item may (pp.122–129), and psychodynamic
for personal use. or thrown away. have no therapies (pp.118–121) to explore
monetary the underlying causes and put in
value. place more appropriate ways of
dealing with distress.

❯❯Selective serotonin reuptake
inhibitors (SSRIs) (pp.142–143)
along with therapy.

Pyromania 84 85

A person with pyromania sets fires purposely. This very rare
impulse-control disorder is triggered by stress, and the action
provides relief from tension or distress.

What is it? Destructive cycle

Also known as firesetting, The cycle of obsession Fire, its aftermath,
pyromania is an obsessive desire and gratification is difficult and fire-related
to light fires. It can be a chronic to break. equipment and
(long-term) problem, or restricted to
several occurrences during a period personnel fascinate
of unusual stress. A person with the person.
pyromania is excessively fascinated
with making fires and situations Feelings Tension builds
involving fire, as well as witnessing of euphoria and up, leading to
or assisting in the fire’s aftermath. relief result from a strong desire
seeing the fire. to light a fire.
Individual factors that contribute
to pyromania may include Lighting the fire
antisocial behaviors and attitudes, gratifies over-
sensation and/or attention seeking, whelming urge.
lack of social skills, and inability to
cope with stress. Parental neglect
or emotional detachment, parental
psychological disorders, peer
pressure, and stressful life events
can all be triggers in both children
and adults. Interviews with
affected children and teens often
identify a chaotic household, in
which case a whole-family
approach to treatment is required.

TREATMENT PYROMANIA IN CHILDREN, TEENS, AND ADULTS

❯❯Cognitive and behavioral ❯❯In children and teens firesetting ❯❯In adults pyromania has been
therapies (pp.122–129) tailored may be a cry for help, or part of a linked to symptoms that include
to children to include problem- larger pattern of aggression. Teens depressed mood, thoughts of
solving and communication skills, may be influenced by antisocial suicide, and poor interpersonal
anger management, aggression adults in their community. Some relationships. It is often associated
replacement training, and are diagnosed with psychotic or with psychological problems such
cognitive restructuring; long-term, paranoid disorders (pp.70–75), and as OCD (pp.56–57).
insight-oriented psychotherapy others may be cognitively impaired.
for adults.

DID (dissociative
identity disorder)

In this rare and severe condition, a person’s identity is
fragmented into two or more distinct personality states.
The parts do not join up into a whole.

What is it? extreme than forgetfulness. They Identity alteration
may not remember people, places,
A person with DID has a splintered and events in their lives from the Each alter, as the identity fragments
identity, rather than a growth of distant and recent past, yet vividly of someone with DID are called, has
separate personalities, which is relive other things that have distinct patterns of perception and
why the name of the condition was happened. The person has personality that recur and take
changed from its previous term of moments of absence while carrying control of the individual’s behavior.
multiple personality disorder. out day-to-day activities and may Typically the personalities know each
travel somewhere but be unable other and communicate, sometimes
The individual feels as though to remember how they got there. criticizing one another. The transition
they have different people within from one to another is sudden and
(called alters). Each alter has its The person regularly experiences the person has no control over which
own persona, with its own pattern symptoms of personality change one is in charge, but certain stressors
of thinking and communicating, and dissociation. These symptoms can make a particular alter emerge.
even down to different handwriting are thought to be a way of coping
and physical requirements, such as that often goes back to severe and TREATMENT
wearing glasses. Someone with prolonged trauma experienced in
DID finds it hard to define what childhood, but the dissociation ❯❯Psychotherapies, such as
they are like, and may refer to disrupts everyday life long after cognitive behavioral therapy
themselves as “we.” They have no the trauma has ceased. Affected (p.125), to reappraise the trauma
control over when and which alter individuals continue to use the and develop psychological
takes over, and for how long. dissociation as a way of coping in flexibility to help deconstruct the
all stressful situations in later life. personalities and reunite them
Dissociative experiences into one. Treatment is long-term.
How is it diagnosed?
An individual with DID uses ❯❯Dialectical behavior therapy
dissociation—disconnection from If a specialist suspects DID, they (p.126) to treat any self-harming
the world around them—as a will complete mental health and suicidal behaviors.
defense mechanism. They may questionnaires that capture and
feel as if they are floating away, rate the person’s symptoms. ❯❯Anti-anxiety medication and
watching themselves from outside. antidepressants (pp.142–143) often
As if in a movie, the person The aberrant and inexplicable prescribed to help the person
observes rather than feels their behavior that characterizes DID cope with associated conditions.
emotions and parts of their body. is distressing and confusing for the
The world around a person affected individual and impacts negatively
by DID may seem unreal and hazy, on work, social life, and intimate
with objects changing appearance. relationships. DID often exists
alongside anxiety and depression
The individual has significant (pp.38–39), panic attacks, OCD
and frequent gaps in memory, (pp.56–57), hearing voices, and
unable to recall personal suicidal feelings.
information in a way that is more

PSYCHOLOGICAL DISORDERS 86 87
DID (dissociative identity disorder)

8−13 the typical number of identities in people
with dissociative identity disorder

A younger self Opposing
may talk in a attitude
from the host’s
childlike way or identity provides
even be unable a different
perspective on
to talk. life events.

LIZ SWITCHING Another
BETWEEN gender or age
Different name
can denote a switch ALTERS changes
to the thinking patterns memories or
perceptions of
of another alter.
events.

Different The host identity Change of role
appearance, is the one main alter that a person can enable a view of life
for example, hair may feel is most like them. This host
color or clothing identity may not remember facts events from another
style, can change about their personal history when standpoint.
the host’s persona.
a different alter is in control.

Depersonalization
and derealization

These are two related dissociative disorders. Depersonalization makes a
person feel disconnected from their thoughts, feelings, and body, whereas
derealization makes them feel disconnected from their environment.

What are they? because they are neurologically less reactive to
emotions or they may have a personality disorder
The feelings that result from these two conditions (pp.102–107). The disorders can be triggered by
can be very disturbing and seriously interfere with a intense stress, trauma, or violence.
person’s ability to function. Some people fear they are
going mad, or become depressed, anxious, or panicky. If symptoms are present, a clinical assessment will
People with depersonalization describe feeling like a include a full medical history and physical examination
robot and not in control of their speech or movement, to rule out illness or side effects of medication, and
as if they are an outside observer of their own thoughts questionnaires will be completed to identify associated
or memories. They may also feel that their body is symptoms and possible triggers. An individual is
distorted. With derealization a person can feel diagnosed with depersonalization and/or derealization
alienated and disconnected from their surroundings. disorder only when they persistently or repeatedly
In some, the symptoms for these disorders are mild suffer from distorted perceptions of detachment from
and short-lived, whereas in others they may persist themselves or their environment. Many people
for months or even years. experience a temporary feeling of dissociation from
their thoughts or surroundings at some point in their
Little is known about what causes these disorders, lifetime, but fewer than 2 percent of people will be
but biological and environmental factors may play a identified as having one, or both, of these disorders.
role. Some people appear to be more prone to them,

THE TREATMENT
“REAL”
PERSON ❯❯Psychotherapies, particularly cognitive behavioral
therapy (p.125), psychodynamic therapy (pp.118−121),
or mindfulness meditation (p.129) can help a person
understand why the feelings occur, learn coping
strategies to manage the situations that trigger them,
and gain control over symptoms.

❯❯Medication, such as antidepressants (pp.142−143),
can be prescribed to treat any associated disorders,
including anxiety and depression.

THE Out-of-body experience
“OBSERVER”
A person can be so dissociated from reality that they
feel as if they are observing themselves in a movie and
cannot relate to the individual in the real world.

Dissociative 88 89
amnesia
TREATMENT
This is an often short-term, dissociative disorder in
which a person becomes separated from their personal ❯❯Psychotherapies, such as
memories following stress, trauma, or illness. cognitive behavioral therapy,
dialectical behavior therapy, eye
What is it? remember their name, job, home, movement desensitization and
family, and friends. They may reprocessing, family therapy, and
Dissociative amnesia is often disappear and be reported art therapies such as hypnosis or
linked to overwhelming stress, missing. They might even create mindfulness meditation can help
such as witnessing or suffering a totally new identity, fail to the person understand and deal
from abuse, an accident, or a recognize people or places from with the stress that triggered the
disaster. The resulting severe their past life, and be unable disorder, and learn coping
memory loss often affects specific to explain themselves—this is strategies (pp.118−141).
recollections, such as a certain known as a dissociative fugue.
period during childhood, or ❯❯Medication, such as
something associated with Clinical diagnosis will antidepressants, may be
a friend, relative, or peer. involve completing assessment prescribed for the depression or
Alternatively, the amnesia may questionnaires that help identify a psychosis that can be associated
focus on a traumatic event, for trigger and enable the individual to with the amnesia (pp.142−143).
example, a crime victim may capture and rate their symptoms.
have no memory of being robbed Physical checks and psychological
at gunpoint, but can recall examinations are also carried
details from the rest of that day. out to exclude other
A person may develop generalized medical causes of
memory loss and may not memory loss.

2−7%

of people have
dissociative amnesia

Memory recovery

Most cases of dissociative amnesia are short-
term, and while memories may temporarily
fall away, they often return suddenly and
completely. The recovery may happen on its
own, after being triggered by something in the
person’s surroundings, or in a therapy session.

Anorexia nervosa

With this serious emotional disorder, a person wants to weigh as
little as possible. They develop an aversion to food and their appetite
reduces as they eat less and less.

What is it? over life events, such as losing a anorexia can make it hard to
job, relationship breakdown, or maintain relationships. It can also
A person with anorexia becomes so bereavement, which makes the have an irreversible impact on the
afraid of gaining weight that they person exert excessive control over body and cause infertility or serious
cannot eat normally. They may take internal processes that are within pregnancy complications.
appetite suppressants, laxatives, or their power.
diuretics (to remove body fluid), or How is it diagnosed?
make themselves vomit after meals Anorexia affects more females
(bulimia nervosa, pp.92−93), but than males. Many of those who The GP, clinical psychologist, or
they may also binge (binge-eating develop it share personality and specialist health professional asks
disorder, p.94). behavioral traits. They are often the individual questions about their
emotionally controlled, have a personal and family history, weight,
Many factors can trigger anorexia. tendency toward depression and and eating habits. The person
Pressures at school, such as exams anxiety, find it difficult to handle needs treatment as early as
or bullying (particularly if the focus stress, and worry excessively. Many possible to reduce the risk of
is on body weight or shape), can individuals set themselves strict, complications. In most cases,
contribute, as can occupations such demanding goals. They may have the treatment plan involves
as dancing or athletics where being feelings of obsession and psychotherapy and individually
thin is considered “the ideal.” The compulsion, but not necessarily tailored advice on eating and
disorder can also be a response to OCD (pp.56–57). Living with nutrition. Recovery can take years.
stress in childhood or lack of control

TREATMENTS feels, and acts, as well as the events Symptoms
and relationships that underlie of anorexia
❯❯Multidisciplinary care team, their past experiences—often
including a GP, psychiatrists, in childhood. All symptoms relate to self-esteem,
specialist nurses, and dietitians to body image, and feelings, and divide
ensure that a person gains weight ❯❯Interpersonal therapy to resolve into three main categories: cognitive
safely and to support family and problems with attachment and (feelings and thoughts), behavioral,
close friends. relating to other people. and physical.

❯❯Cognitive behavioral therapy ❯❯Focal psychodynamic therapy 46%
(p.125) to help the person to explore how early-childhood
understand and explain their experiences may have affected of people
problem and see it as a cycle of the person. with anorexia
triggers, thoughts, feelings, and recover fully
behaviors. Therapist and patient ❯❯In-patient treatment for severe
collaborate on interventions that cases; supervised weight gain
break the chain of thoughts through strict daily routines and
maintaining anorexia. eating plans, often including group
therapy for peer support.
❯❯Cognitive analytic therapy to
examine the way the person thinks,

PSYCHOLOGICAL DISORDERS 90 91
Anorexia nervosa

Perceived body weight Cognitive symptoms
is too high and the person
❯❯Expresses a fear of gaining weight and
feels compelled to lose becomes obsessed with body shape.
weight.
❯❯Believes that being thin is good and is
Actual body weight convinced that they are overweight.
and BMI are much
lower than is healthy ❯❯Measures self-worth in terms of body
for their age and weight and shape.
height.
❯❯Obsesses about food and the perceived
negative consequences of eating.

❯❯Becomes irritable, moody, and unable
to concentrate (partly due to hunger),
which impacts school or work.

Behavioral symptoms

❯❯Behaves obsessively around food and
diets, and counts calories excessively.
Avoids “fatty” foods and/or eats only
low-calorie foods. May skip meals.

❯❯Avoids eating in front of others, and/or
purges after eating.

❯❯Lies about how much they eat.
❯❯Repeatedly weighs themselves or checks

their body shape in the mirror.
❯❯Exercises obsessively.
❯❯Becomes socially withdrawn.

Physical symptoms

❯❯Obvious weight loss.
❯❯Irregular or absent periods in females.
❯❯Poor dental health and smelly breath

due to persistent vomiting.
❯❯Soft, fine, “downy” hair growing on the

body, while head hair falls out.
❯❯Has difficulty sleeping but is very tired.
❯❯Is weak, light-headed, and dizzy.
❯❯Has stomach pains, and is constipated

and bloated.
❯❯Has swollen hands and feet.

Bulimia nervosa

A serious eating disorder, bulimia is characterized by a person
controlling their weight through severely restricting intake,
then binge eating and purging the body of the food.

What is it? events—although in fact it makes DIAGNOSING BULIMIA
daily living a struggle—and is
People with bulimia have an linked to depression, anxiety, and Doctors all over the world use the
abnormal fear of putting on weight social isolation. Pressure to conform so-called SCOFF questionnaire
and so become obsessed with to body shapes promoted by the (developed in the UK) to diagnose
food and dieting. Unlike those fashion and beauty industries and anorexia (pp.90–91) or bulimia.
with anorexia (pp.90–91), they are a family history of bulimia increase Two or more “yeses” indicate a
usually at or near a normal weight the risk. Bulimia is more common likely case.
for their height and build. However, in females, but incidence in males
like a person with anorexia, they is rising. Puberty and self- ❯❯Does the person make themselves
have a distorted self-image and consciousness are often triggers, Sick (vomit) after eating?
believe they are too fat. and boys and girls in their teens
are especially vulnerable to bulimia ❯❯Has the person lost Control over
A person with bulimia may often if teased as an overweight child. how much they eat?
appear tense or anxious and
behave furtively, rapidly consuming Bulimia can cause irreversible ❯❯Have they lost more than One
large amounts of food in secret damage to the heart, bowels, teeth, stone (13lb) within three months?
before disappearing to the and fertility. Treatment depends
bathroom to make themselves on the severity of the condition, and ❯❯Does the person believe they are
vomit. This behavior is a recovery can be a long process. Fat even though others have told
mechanism for coping with life them they are too thin?

❯❯Does Food dominate their life?

Binge−purge cycle A strict diet Food cravings Bingeing
seems to be the set in, which provides
The person has a low self-opinion and sees temporary
losing weight as a way of gaining self- best solution before long are relief from
worth. They may also exercise fanatically to avoid weight irresistible. unhappiness.
to burn off the additional calories and LOW
avoid social occasions that involve food. gain. SELF-
ESTEEM
Causes
Guilt and Purging brings
❯❯The individual may have a caregiver shame result a short-term
who thinks looks are important and from the purging,
criticizes their weight or appearance. respite from the
leading to fear of gaining
❯❯The person may want to take control depression.
of an aspect of their lives, particularly weight.
if recovering from a traumatic event.

❯❯Images of celebrities with flawless, thin
bodies trigger the start of a strict diet.

❯❯Despair sets in when the person cannot
keep to the diet.

PSYCHOLOGICAL DISORDERS 92 93
Bulimia nervosa

TREATMENT

❯❯Psychotherapies such as group
therapy, self-help, or one-on-one
cognitive behavioral therapy
(p.125) or interpersonal therapy.

❯❯Antidepressants (pp.142−143)
prescribed along with therapy.

❯❯In-patient treatment needed
in extreme cases.

1.5%

of American
women have or
have had bulimia
in their lifetime

Physical effects PEOPLE WITH BULIMIA
feel as if they have no
❯❯Frequent weight gain and loss. control over eating habits,
which increases their fear
❯❯Bad breath, stomach pain, sore of weight gain.
throat, and damaged tooth
enamel from acid levels in vomit.

❯❯Dry skin and hair, hair loss, brittle
nails, lethargy, and other signs of
poor nutrition.

❯❯Heart strain, hemorrhoids, and
weak muscles from misuse and
overuse of laxatives and diuretics.

❯❯Irregular/absent periods in
females.

❯❯Feeling bloated and/or
constipated.

❯❯Bloodshot eyes.

❯❯Calluses on the back of hands
from induced vomiting.

Binge-eating
disorder

With this condition, a person regularly overeats to cope with
low self-esteem and misery, although in fact the persistent,
uncontrolled binge eating makes depression and anxiety worse.

What is it? events, and a family history of TREATMENT
eating disorders are all factors that
A person with binge-eating increase the risk of developing it. ❯❯Psychotherapy (pp.118–141) in
disorder regularly eats large The disorder can also develop after groups or one-on-one.
amounts quickly when not hungry, the person follows such a strict diet
alone or secretly, and feels shame that they are left very hungry and ❯❯Self-help programs through
and self-disgust after a binge. They have food cravings. It is the most books, in online courses, as part
feel they have no control over how common eating disorder in the US. of a support group, or supervised
much and how often they eat. by a health professional.
A GP may diagnose the disorder
Low self-esteem, depression, from the person’s weight gain—the ❯❯Antidepressants (pp.142–143)
anxiety, stress, anger, boredom, most common physical effect. prescribed along with therapy.
loneliness, dissatisfaction with the
body, pressure to be thin, traumatic

Bingeing Anxiety rises and Relief from
cycle depression sets in increasingly
as eating provides distressing feelings
People with a binge- only short-lived comes only with
eating disorder are using thoughts of food.
food as an instant, albeit “pain” relief.
negative, way to relieve The need to eat to
emotional pain instead relieve depression grows
of finding positive in urgency; the person
methods of tackling
the underlying cause. plans a binge, often
The result is a perpetual buying special foods
cycle of eating, relief,
depression, and yet for that purpose.
more eating.
Low mood returns
with self-disgust The person eats large
amounts of food rapidly
because of the guilt (regardless of degree of
and shame associated hunger), often in secret,
may be in a dazed state
with binge eating.
while eating, and may
Anxiety drops as feel uncomfortably full
eating temporarily
numbs the feelings afterward.
of stress, sadness,

or anger.

Pica 94 95

An individual with this eating disorder persistently eats
substances that are not food, such as dirt or paint. It can lead to
serious complications if the substance is dangerous when ingested.

What is it? damage from sharp objects.

Children and adults with pica may For a doctor to diagnose pica, the TREATMENT
eat, for example, animal feces, clay, pattern of behavior must last for
❯❯Behavioral therapies (pp.122–
dirt, hairballs, ice, paint, sand, or at least one month. After a medical 129) to associate healthy eating
with positive reinforcement or
metal objects such as paper clips. It examination to rule out causes such reward. Positive behavior support
to address aspects of family and
is more common in children than as nutrient deficiency or anemia home environment and minimize
recurrence.
adults—between 10 and 32 percent as the root of the unusual cravings,
❯❯Medication to enhance
of children age 1–6 years are a specialist health professional dopamine levels; supplements to
affected by pica. The odd eating evaluates the presence of other remedy any nutrient deficiencies.

behavior can create complications disorders such as developmental

such as lead poisoning or intestinal disabilities or OCD (pp.56–57).

28% of pregnant women
are affected by pica

RARER EATING DISORDERS

Irregular eating habits, eating unusual items, distress or avoidance around eating or mealtimes,
or concerns about body weight or shape characterize eating disorders.

NAME WHAT IS IT? CAUSES SYMPTOMS IMPACT TREATMENT

PURGING Deliberate Childhood abuse Vomiting after Anxiety, Management of
DISORDER vomiting that or neglect, social meals, laxative depression, and medical problems,
occurs often media stresses, or use, obsession with suicidal thoughts healthy eating plan,
NIGHT-EATING enough after eating family history weight/appearance, that affect nutrition education,
DISORDER to affect physical tooth decay, relationships, work, psychotherapy
health bloodshot eyes and self-esteem
RUMINATION
DISORDER Urge to eat most Depression, low Insomnia, grazing Problems with Psychoeducation
of the daily food self-esteem, or in the evening, work, social, or about the disorder
requirement during response to stress waking in the intimate and nutritional
the late evening or or dieting night to eat relationships; and behavioral
at night weight gain or therapy
substance abuse

Tendency in young Neglect or Regurgitation and Usually outgrown Family therapy and
children who abnormal rechewing food, in early years; if it positive behavior
have intellectual relationship with weight loss, poor persists, impacts support
disability to rechew parent or caregiver; teeth, stomach daily life
partly digested may be attention pains, raw lips
food seeking

Communication
disorders

This range of conditions affects a person’s ability to receive, send,
process, and/or understand verbal, nonverbal, and visual concepts and
may be apparent in hearing, language, and/or speech.

What are they? be involved. Psychiatric disorders, TREATMENT
ASD (pp.68–69), Down syndrome,
The four main conditions are cerebral palsy, and physical ❯❯Speech and language therapy
language, childhood fluency, problems including cleft lip or essential to help language skills,
speech-sound, and SCD (social palate and deafness may limit a speech-sound production and
communication disorders). They are person’s ability to communicate. rules, fluency, and nonverbal
often complex. Some are apparent gestures; for stutterers, support to
in babies and toddlers, whereas How are they diagnosed? control and/or monitor rate of
others may not become obvious speech and breathing.
until a child is at school. To maximize a child's development
potential, early intervention is ❯❯Positive behavior therapies to
The causes are wide-ranging. important; some conditions require improve the relationship between
Communication disorders may lifelong management. A speech and behavior and communication.
develop of their own accord or language specialist takes a case
stem from a neurological illness. history, including information about ❯❯Family therapy, special
They can be genetic—20–40 family background, medical educational support, and
percent of children with a family conditions, and information from environmental adaptations to
history of speech and/or language teachers and caregivers, to prepare support language development.
impairment have communication a treatment plan.
disorders. Prenatal nutrition may

CAUSES OF COMMUNICATION DISORDERS

More than one causal factor may be involved and the effects can range from mild to profound.

DISORDER TRIGGER

LANGUAGE DISORDER FAMILY HISTORY OF
SPEECH-SOUND DISORDER LANGUAGE
CHILDHOOD FLUENCY DISORDER IMPAIRMENTS
SOCIAL COMMUNICATION DISORDER CHILDHOOD
DEVELOPMENT
DISORDER
GENETIC SYNDROME
IMPAIRED OR NO
HEARING
EMOTIONAL OR
PSYCHIATRIC
DISORDER
PREMATURE BIRTH
NEUROLOGICAL
ILLNESS OR DAMAGE
POOR DIET

PSYCHOLOGICAL DISORDERS 96 97
Communication disorders

LANGUAGE IMPACT SPEECH–SOUND
DISORDER ON THE DISORDER
CHILD
The child does not understand The child has difficulty articulating
others (receptive disorder) or Errors of thinking and sound patterns and mispronounces
cannot communicate thoughts communication affect daily words beyond expected age range.
(expressive disorder) or both interactions. Children become
(receptive-expressive disorder). anxious, with low self-confidence. ❯❯Unclear speech, common in
❯❯ Developmental milestones young children, continues beyond
❯❯Baby does not smile or babble are delayed as children learn the age of eight.
in response to parents, and only through communication.
has a few words by 18 months. ❯❯Child unable to produce
❯❯Social isolation occurs correct sound patterns even
❯❯Child does not play with others because child does not though they can understand
and prefers to be alone. May initiate interaction and speech, so cannot make
become shy and distant. cannot make friends. May themselves understood by others.
become target of bullies.
❯❯Child has difficulty swallowing, ❯❯Limited understanding of rules
affecting ability to speak. ❯❯Behavioral issues arise of speech sounds is apparent.
as child adopts avoidance
CHILDHOOD techniques and may become SCD
FLUENCY aggressive if they cannot
resolve speech difficulties. The child cannot process
The child stammers or stutters, verbal and visual information
repeating words or parts of words, simultaneously.
and prolonging speech sounds.
❯❯Child cannot adapt language to
❯❯Speech can become blocked as suit situation, so can be dogmatic,
if child is out of breath. dominating, and inappropriate
when talking to adults or peers.
❯❯Child uses distracting sounds
such as throat clearing or head ❯❯Child lacks nonverbal
and body movements to disguise communication skills such as
their problem. taking turns in conversation or
other group activities.
❯❯Anxiety is increasingly evident
as child tries to hide disorder. ❯❯Child cannot greet people as
they have little or no interest in
❯❯Child avoids public speaking as social interaction.
anxiety worsens the stutter.

SOCIAL COMMUNICATION DISORDER OR AUTISM SPECTRUM DISORDER?

SCD (social communication disorder) has many symptoms in common with ASD (autism spectrum disorder). Assessment
must rule out ASD before doctors diagnose the child with SCD and establish a treatment plan.

Social communication disorder Autism spectrum disorder

Children with SCD find it difficult to learn the basic rules Children with ASD find it hard to relate to people,
of conversation: how to start one, listen, phrase questions, emotions, and feelings. As with SCD, this can result in
stay on topic, and know when it is over. SCD can occur communication difficulties, impaired social skills, and
alongside other developmental issues such as language altered sensory and visual perception. But ASD has
impairment, learning disabilities, speech-sound disorder, an additional defining characteristic of restricted or
and ADHD (pp.66–67). repetitive behaviors.

Sleep disorders

This is a group of conditions that affects a person’s ability to sleep
well. Their cause may be psychological or physiological, but they
can all result in disturbed thoughts, emotions, and behaviors.

What are they? HYPP INSOMNIA WHAT IS IT?
NCE ARASOMNIA
Most people experience sleep problems from Insomnia is difficulty in
time to time. The problem becomes a disorder NARCOLEPSY getting to sleep and/or
if it occurs regularly and interferes with daily ERSOM NOLE staying asleep long enough
life and mental health. Lack of refreshing to feel refreshed the next
sleep can have a negative impact on energy, day. Episodes can be
mood, concentration, and overall health— short-lived or continue for
disorientation, confusion, memory problems, months or years. It is more
and speech disturbances can result, which common in older adults.
may in turn worsen the disorder.
Parasomnias are a group
Sleep involves transitions between three of unwanted events,
different states: wakefulness; REM (rapid eye experiences, or behaviors
movement) sleep, which is associated with that occur while a person is
dreaming; and N-REM (non-rapid eye falling asleep, sleeping, or
movement) sleep. Disorders include abnormal waking. The person remains
occurrences not only during sleep but also just asleep throughout and has
before sleep and immediately on waking. For no memory of them.
example, a person may have difficulty falling
and/or staying asleep (insomnia) and then feel Narcolepsy is a long-term
extremely tired throughout the day. A person’s disorder that can develop
sleep may be disturbed by abnormal behavior if the brain is unable to
or events (parasomnias), such as sleepwalking, regulate sleeping and
nightmares, sleep terrors, restless leg waking. It is characterized
syndrome, sleep paralysis, and sleep by irregular sleep patterns
aggression. Confusional arousal makes a and suddenly falling asleep
person behave in a strange and confused way at inappropriate times.
when they wake up. REM sleep behavior
disorder is a severe parasomnia that causes Hypersomnolence is
sleep-related groaning and often causes a excessive sleepiness that
person to physically enact their dreams. intrudes on daily functions.
It can be mild and transient,
What are the causes? or persistent and severe,
and it often accompanies
Sleep disruption can be associated with depression. It mostly affects
medications, underlying medical conditions teens and young adults.
(for example, narcolepsy), and sleep-related
breathing conditions. The latter includes a
range of anomalies from snoring to obstructive
sleep apnea (a condition in which the walls of
the throat relax and narrow during sleep,
interrupting normal breathing), which causes
the person to wake up in distress.