This is the 2007 version. Click here for the 2017 chapter 12 table of contents.

Summary: Axis 1 of DSM-IV

Psychosis is characterized by a "break from reality." The most common psychosis is schizophrenia, which comes in several varieties: undifferentiated, disorganized, catatonic, and paranoid schizophrenia. Symptoms of schizophrenia include delusions (highly unrealistic belief systems treated as true), imagined voices (often attributed to outside sources such as aliens or radio transmissions), and disorders of affect (such as laughing at inappropriate times).

Disorganized speech is very typical of disorganized schizophrenia. Sometimes schizophrenics speak in a "word salad" which makes no sense, or they use "clang associations" stringing together words that sound superficially similar.

There is evidence of a genetic component to schizophrenia. If one member of a pair of identical twins is schizophrenic, the other is likely to be also. However, this does not always occur, so there is more to the disorder than just a genetic defect. Some experts point out the importance of stress, for example, from the family environment, in triggering or worsening schizophrenia. If a family situation can be improved, sometimes a schizophrenic person can function almost normally in daily life.

Historically, schizophrenia has been regarded as recurrent and disabling, meaning that there is no effective cure and the disease eventually wears people down to the point where they cannot function in day-to-day life. However, new medications such as Clozapine are producing dramatic improvements in some individuals, and there is hope that more effective new medications will be discovered.

Mood disorders are called affective (AFF-ect-iv) disorders. Depression is the most common. It comes in all degrees of severity; at its worst, it is disabling. A person with a "clinical strength depression" is unable to function and may feel suicidal. People with depression report great pain, and a person who suffers one depressive episode has about a 50% chance of suffering another.

Women are nearly twice as likely to suffer from depression as men. This may be due to hormonal differences between the sexes, or men may mask their depression with alcoholism and other symptoms. Women may experience depression after childbirth, and some people experience depression during the winter, particularly in northern latitudes. While holidays make some people depressed, there is no statistical tendency for depression to be more common around Christmas, as some people believe.

Mania is characterized by wild activity and a "flight of ideas." Sometimes it is combined with depression in the so-called manic-depressive disorder, technically known as the bipolar disorder. Lithium and other drugs can help to dampen the oscillations between mania and depression.

Anxiety disorders are characterized by feelings of dread, discomfort, and alarm. They include generalized or free-floating anxiety, panic attacks, phobic reactions, and the obsessive-compulsive disorder (OCD).

Generalized or free-floating anxiety is a constant feeling of worry or fear that cannot be related to any particular danger. Panic attacks, by contrast, are often triggered by particular situations such as being in a crowd. Agoraphobia, a fear of crowds and public places, is often triggered by a series of panic attacks that occur in those settings. Panic attacks involve well-known neurotransmitter systems resembling adrenaline, and they can often be treated successfully with medications. The therapy called desensitization also works well with some forms of panic attack.

Obsessive-compulsive disorder (OCD) is a unique syndrome characterized by intrusive patterns of thinking (obsessions) and irrational urges to repeat certain behaviors (compulsions). A common feature of OCD is checking. An OCD sufferer may check to make sure the front door is locked...not once, but five times...and still be tormented by the idea that maybe the door is actually unlocked.

One common variety of OCD involves excessive hand washing. Triggered by a fear of contamination, the hand washing may be so frequent that the skin of the hands is rubbed raw and starts to crack and bleed. OCD sufferers often realize that their compulsions are irrational but feel helpless to change them. OCD has a "biological side." It tends to run in families, and sometimes it can be cleared up with prescription medications.

Somatoform disorders are psychological problems with physical or bodily manifestations. The somatization disorder is characterized by many vague complaints with no known physical cause. Conversion disorders are characterized by a symbolic relationship between the trauma and the symptom; for example, a person who stabs somebody and feels guilty about it might experience a loss of sensation in the hand that held the knife.

Hypochondriasis is an excessive concern with illness that cannot be found by medical professionals. So-called "closet hypochondriacs" are extremely health-conscious people who may perform daily rituals of checking their bodies for signs of disease and often become involved in health fads.

Body dysmorphic disorder (BDD) is characterized by an obsession with bodily appearance based upon an imagined or exaggerated defect. Sufferers of this disorder may be unable to function normally, as they shut themselves off from the world to avoid letting others see their imagined horrible appearance.

Dissociative disorders involve a split (dissociation) between normal consciousness and some other brain process that temporarily controls behavior. Some dissociative states, such as "driving on autopilot," are normal. Less normal, and less common, is the dissociative fugue state, in which a person suffers a temporary lapse of consciousness while acting out a complex behavior. Fugue states are most common in people who have suffered from seizure disorders and may be due to seizure-like activity in the brain.

The most dramatic dissociative state is multiple personality disorder, which was renamed dissociative identity disorder (DID) in DSM-IV. The best-authenticated cases of multiple personality involve trauma during early childhood. Other dissociative disorders include dissociative amnesia, in which autobiographical memory is temporarily lost, and depersonalization disorders, in which a person feels cut off or alienated from his or her own body. DSM-IV also includes a category called Factitious Disorders that covers cases in which a person fakes illness or seeks to gain attention by creating illness in another person.

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