This paper provides a concise overview of key mental disorder classifications found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American Psychiatric Association. It examines three major categories: anxiety disorders, mood and affective disorders, and dissociative/somatoform disorders. For each category, the paper describes clinical symptoms, known causes, common diagnoses, treatment approaches, and general prognosis. The discussion highlights the roles of both psychotherapy and medication across disorder types and notes the challenges posed by conditions — particularly somatoform disorders — where patients may resist psychological explanations for their symptoms.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition — also known as the DSM-IV — is published by the American Psychiatric Association. It contains diagnostic criteria and clinical descriptions of all recognized mental health disorders. This information includes the known causes of each disorder, relevant statistics, age of onset, and prognosis. Treatment approaches and current research findings are also included. The manual is used by clinicians and researchers to better understand their patients' illnesses and to identify optimal treatment options.
The main feature of anxiety disorders is anxiety that rises to inappropriate or abnormal levels. Physically, anxiety manifests as an increased heart rate, tensed muscles, and often an acute sense of alertness. Normal anxiety escalates into a disorder when there is no recognizable stimulus to account for the elevated anxiety. When no medical cause can be identified, a psychological disorder may be at the root of the problem.
Specifically, the DSM-IV includes disorders such as acute stress disorder, agoraphobia, obsessive-compulsive disorder, panic disorder, and phobias under the heading of anxiety disorders. Many of these conditions are the result of a traumatic event in the individual's past, in which threat, injury, or death was experienced or feared. The person's response to that situation would have produced extreme anxiety, which later developed into a persistent anxiety disorder.
Physical symptoms across specific disorders range from dissociation to obsession, persistent worry, or intense anxiety. Psychological symptoms include excessive feelings of helplessness, worry, or obsession — which are generally irrational. The more severe disorders may also involve panic or a compulsive need to escape or hide.
Treatments for anxiety disorders generally include a combination of psychotherapy and medication. Depending upon the severity of the disorder, medication may be used only for a limited period, while psychotherapy continues on a longer-term basis. Treatment decisions also depend on how readily identifiable the various symptoms are. Medication may be discontinued as symptoms resolve, though newly emerging symptoms may require additional pharmacological intervention.
In general, the prognosis for anxiety disorders is good. With the correct medication and psychotherapy, individuals who suffer from these disorders can function well in society. Some disorders, however, require a more targeted and long-term approach, and care must be taken as the individual re-enters social and workplace environments.
Mood disorders manifest in persons who experience significant disturbances in mood. Affected individuals are often subject to inappropriate, exaggerated, or restricted emotional responses. Excessive crying, depression, suicidal ideation, or — at the opposite extreme — periods of intense energy during which the individual does not sleep for days are among the common symptoms. During episodes of extreme energy, the individual may be unable to make sound decisions. Mood disorders recognized by the DSM-IV include bipolar disorder, cyclothymic disorder, dysthymic disorder, and major depressive disorder.
Generally, mood disorders are influenced by both biological and environmental factors; in other words, these disorders can have a heritable component. Bipolar and cyclothymic disorders typically involve both euphoric and depressive episodes, while dysthymic and major depressive disorders involve depressive symptoms only. Bipolar disorder and major depressive disorder have received the most research attention. Both are generally treated with a combination of medication and psychotherapy and, being more severe than the other two categories, may at times require hospitalization to ensure patient safety.
Cyclothymic and dysthymic disorders are both less severe, but can still be disruptive if not appropriately treated. The prognosis for both conditions is generally good with respect to functioning effectively in society. The more severe mood disorders may impair social and occupational functioning, although the correct combination of psychotherapy and medication can significantly enhance quality of life.
"Physical symptoms without medical cause; treatment challenges"
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