{"id":56,"date":"2020-07-13T18:18:19","date_gmt":"2020-07-13T18:18:19","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/chapter\/diagnosing-and-classifying-psychological-disorders\/"},"modified":"2022-12-06T15:41:04","modified_gmt":"2022-12-06T15:41:04","slug":"diagnosing-and-classifying-psychological-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/diagnosing-and-classifying-psychological-disorders\/","title":{"raw":"Diagnosing and Classifying Mental Disorders","rendered":"Diagnosing and Classifying Mental Disorders"},"content":{"raw":"<div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe the basic features of the <em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition<\/em> (DSM-5) and how it is used to classify disorders<\/li>\r\n \t<li>Outline the major disorder categories of the DSM-5<\/li>\r\n<\/ul>\r\n<\/div>\r\nA first step in the study of mental disorders is carefully and systematically discerning significant signs and symptoms. How do mental health professionals ascertain whether or not a person\u2019s inner states and behaviors truly represent a psychological disorder? Arriving at a proper <strong>diagnosis<\/strong>\u2014that is, appropriately identifying and labeling a set of defined symptoms\u2014is absolutely crucial. This process enables professionals to use a common language with others in the field and aids in communication about the disorder with the patient, colleagues, and the public. A proper diagnosis is an essential element to guide proper and successful treatment. For these reasons, classification systems that organize psychological disorders systematically are necessary.\r\n\r\n<\/div>\r\n<section>\r\n<h2><em>Diagnostic and Statistical Manual of Mental Disorders<\/em> (DSM-5)<\/h2>\r\nAlthough a number of classification systems have been developed over time, the one that is used by most mental health professionals in the United States is the <strong><em>Diagnostic and Statistical Manual of Mental Disorders<\/em> (DSM-5)<\/strong>, published by the American Psychiatric Association in 2013. Additions and revisions were made in March 2022, so the most current edition is called the <em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision<\/em> (DSM-5-TR). (Note that the American Psychiatric Association differs from the American Psychological Association; both are abbreviated APA.) This textbook includes the updates from the DSM-5-TR, though we typically continue to reference the diagnostic manual simply as the DSM-5.\r\n\r\nThe first edition of the <em>DSM<\/em>, published in 1952, classified psychological disorders according to a format developed by the U.S. Army during World War II (Clegg, 2012). In the years since, the DSM has undergone numerous revisions and editions. The DSM-5 includes many categories of disorders (e.g., anxiety disorders, depressive disorders, and dissociative disorders). Each disorder is described in detail, including an overview of the disorder (diagnostic features), specific symptoms required for diagnosis (diagnostic criteria), <strong>prevalence\u00a0<\/strong>information (what percent of the population is thought to be afflicted with the disorder), and risk factors associated with the disorder. Figure 1\u00a0shows lifetime prevalence rates\u2014the percentage of people in a population who develop a disorder in their lifetime\u2014of various psychological disorders among U.S. adults. These data were based on a national sample of 9,282 U.S. residents (National Comorbidity Survey, 2007).\r\n<figure>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"716\"]<img class=\"\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225103\/CNX_Psych_15_02_Disorders.jpg\" alt=\"A bar graph has an x-axis labeled \u201cDSM disorder\u201d and a y-axis labeled \u201cLifetime prevalence rates.\u201d For each disorder, a prevalence rate is given for total population, females, and males. Appropriate alternative text can be found in the data table displayed below this image. The approximate data shown is: \u201cmajor depressive disorder\u201d 17% total, 20% females, 13% males; \u201calcohol abuse\u201d 13% total, 7% females, 20% males; \u201cspecific phobia\u201d 13% total, 16% females, 8% males; \u201csocial anxiety disorder\u201d 12% total, 13% females, 11% males; \u201cdrug abuse\u201d 8% total, 5% females, 12% males; \u201cposttraumatic stress disorder\u201d 7% total, 10% females, 3% males; \u201cgeneralized anxiety disorder\u201d 6% total, 7% females, 4% males; \u201cpanic disorder\u201d 5% total, 6% females, 3% males; \u201cobsessive-compulsive disorder\u201d 3% total, 3% females, 2% males; \u201cdysthymia\u201d 3% total, 3% females, 2% males.\" width=\"716\" height=\"427\" \/> <strong>Figure 1<\/strong>. The graph shows the breakdown of psychological disorders, comparing the percentage prevalence among adult males and adult females in the United States. Because the data is from 2007, the categories shown here are from the <em>DSM-4<\/em>, which has been supplanted by the DSM-5. Most categories remain the same; however, alcohol abuse now falls under a broader alcohol use disorder category.[\/caption]<\/figure>\r\n<table><caption>Table 1. <em>DSM<\/em> Disorder Lifetime Prevalence Rates<\/caption>\r\n<tbody>\r\n<tr>\r\n<th scope=\"col\"><em>DSM<\/em> Disorder<\/th>\r\n<th scope=\"col\">Total<\/th>\r\n<th scope=\"col\">Females<\/th>\r\n<th scope=\"col\">Males<\/th>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Major Depressive Disorder<\/th>\r\n<td>17%<\/td>\r\n<td>20%<\/td>\r\n<td>13%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Alcohol Abuse<\/th>\r\n<td>13%<\/td>\r\n<td>7%<\/td>\r\n<td>20%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Specific Phobia<\/th>\r\n<td>13%<\/td>\r\n<td>16%<\/td>\r\n<td>8%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Social Anxiety Disorder<\/th>\r\n<td>12%<\/td>\r\n<td>13%<\/td>\r\n<td>11%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Drug Abuse<\/th>\r\n<td>8%<\/td>\r\n<td>5%<\/td>\r\n<td>12%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Post-Traumatic Stress Disorder<\/th>\r\n<td>7%<\/td>\r\n<td>10%<\/td>\r\n<td>3%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Generalized Anxiety Disorder<\/th>\r\n<td>6%<\/td>\r\n<td>7%<\/td>\r\n<td>4%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Panic Disorder<\/th>\r\n<td>5%<\/td>\r\n<td>6%<\/td>\r\n<td>3%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Obsessive-Compulsive Disorder<\/th>\r\n<td>3%<\/td>\r\n<td>3%<\/td>\r\n<td>2%<\/td>\r\n<\/tr>\r\n<tr>\r\n<th scope=\"row\">Persistent Depressive Disorder<\/th>\r\n<td>3%<\/td>\r\n<td>3%<\/td>\r\n<td>2%<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nMore recent data shows that the most prevalent disorders at any given time (not over a lifetime) are anxiety disorders, as shown in the following chart.[footnote]Hannah Ritchie and Max Roser (2018) - \"Mental Health\". Published online at OurWorldInData.org. Retrieved from: 'https:\/\/ourworldindata.org\/mental-health' [Online Resource][\/footnote]\r\n\r\n[caption id=\"attachment_5164\" align=\"aligncenter\" width=\"715\"]<img class=\"wp-image-5164\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/18220658\/prevalence-by-mental-and-substance-use-disorder.png\" alt=\"Prevalence by mental and substance use disorder (2017). Data shows anxiety disorders as most prevalent at 6.64%, depression 4.84%, drug use 3.45%, alcohol use at 2.04%, bipolar 0.65%, eating disorders 0.51%, and schizophrenia 0.33%.\" width=\"715\" height=\"505\" \/> <strong>Figure 2<\/strong>. The prevalence of mental and substance use disorders in the United States.[\/caption]\r\n\r\nThe DSM-5 also provides information about <strong>comorbidity<\/strong>; the co-occurrence of two disorders. For example, the DSM-5 mentions that 41% of people with obsessive-compulsive disorder (OCD) also meet the diagnostic criteria for major depressive disorder (Figure 2). Drug use is highly comorbid with other mental illnesses; six out of 10 people who have a substance use disorder also suffer from another form of mental illness (National Institute on Drug Abuse [NIDA], 2007).\r\n<figure>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"487\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225104\/CNX_Psych_15_02_Comorbidity.jpg\" alt=\"A Venn-diagram shows two overlapping circles. One circle is titled \u201cObsessive-Compulsive Disorder\u201d and the other is titled \u201cMajor Depressive Disorder.\u201d The area in which these two circles overlap includes forty-one percent of each circle. This area is titled \u201cComorbidity 41%.\u201d\" width=\"487\" height=\"337\" \/> <strong>Figure 3<\/strong>. Obsessive-compulsive disorder and major depressive disorder frequently occur in the same person.[\/caption]<\/figure>\r\n<div class=\"textbox key-takeaways\">\r\n<h3><span class=\"os-subtitle-label\">Comorbidity<\/span><\/h3>\r\n<p id=\"zip-idm201856864\">Co-occurrence and comorbidity of psychological disorders are quite common, and some of the most pervasive comorbidities involve substance use disorders that co-occur with psychological disorders. Indeed, some estimates suggest that around a quarter of people who suffer from the most severe cases of mental illness exhibit substance use disorder as well. Conversely, around 10 % of individuals seeking treatment for substance use disorder have serious mental illnesses. Observations such as these have important implications for treatment options that are available. When people with a mental illness are also habitual drug users, their symptoms can be exacerbated and resistant to treatment. Furthermore, it is not always clear whether the symptoms are due to drug use, the mental illness, or a combination of the two. Therefore, it is recommended that behavior is observed in situations in which the individual has ceased using drugs and is no longer experiencing withdrawal from the drug in order to make the most accurate diagnosis (NIDA, 2018).<\/p>\r\n<p id=\"zip-idm500780704\">Obviously, substance use disorders are not the only possible comorbidities. In fact, some of the most common psychological disorders tend to co-occur. For instance, more than half of individuals who have a primary diagnosis of depressive disorder are estimated to exhibit some sort of anxiety disorder. The reverse is also true for those diagnosed with a primary diagnosis of an anxiety disorder. Further, anxiety disorders and major depression have a high rate of comorbidity with several other psychological disorders (Al-Asadi, Klein, &amp; Meyer, 2015).<\/p>\r\n\r\n<\/div>\r\nThe DSM has changed considerably in the half-century since it was originally published. The first two editions of the <em>DSM<\/em>, for example, listed homosexuality as a disorder; however, in 1973, the APA voted to remove it from the manual (Silverstein, 2009). While the <em>DSM-3<\/em> did not list homosexuality as a disorder, it introduced a new diagnosis, ego-dystonic homosexuality, which emphasized homosexual arousal that the patient viewed as interfering with desired heterosexual relationships and causing distress for the individual. This new diagnosis was considered by many as a compromise to appease those who viewed homosexuality as a mental illness. Other professionals questioned how appropriate it was to have a separate diagnosis that described the content of an individual's distress. In 1986, the diagnosis was removed from the <em>DSM-3-R<\/em> (Herek, 2012).\r\n<div class=\"textbox examples\">\r\n<h3>WAtch It<\/h3>\r\nThis video provides an overview of some of the history related to the development and evolution of the <em>DSM<\/em>.\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=UiY6wr--0dE\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/WeWereSuperWrongAboutMentalIllness_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"We Were Super Wrong About Mental Illness: The DSM's Origin Story\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\nAdditionally, beginning with the <em>DSM-3<\/em> in 1980, mental disorders have been described in much greater detail, and the number of diagnosable conditions has grown steadily, as has the size of the manual itself. DSM-1 included 106 diagnoses and was 130 total pages, whereas <em>DSM-3<\/em> included more than twice as many diagnoses (265) and was nearly seven times its size (886 total pages) (Mayes &amp; Horowitz, 2005). Although DSM-5 is longer than <em>DSM-4<\/em>, the volume includes only 237 disorders, a decrease from the 297 disorders that were listed in <em>DSM-4<\/em>. The DSM-5, includes revisions in the organization and naming of categories and in the diagnostic criteria for various disorders (Regier, Kuhl, &amp; Kupfer, 2012), while emphasizing careful consideration of the importance of gender and cultural difference in the expression of various symptoms (Fisher, 2010). The most recent\r\n\r\nSome believe that establishing new diagnoses might over-pathologize the human condition by turning common human problems into mental illnesses (The Associated Press, 2013). Indeed, the finding that nearly half of all Americans will meet the criteria for a <em>DSM<\/em> disorder at some point in their life (Kessler et al., 2005) likely fuels much of this skepticism. The DSM-5 is also criticized on the grounds that its diagnostic criteria have been loosened, thereby threatening to \u201cturn our current diagnostic inflation into diagnostic hyperinflation\u201d (Frances, 2012, para. 22). For example, <em>DSM-4<\/em> specified that the symptoms of major depressive disorder must not be attributable to normal bereavement (loss of a loved one). The DSM-5, however, removed this bereavement exclusion, essentially meaning that grief and sadness after a loved one\u2019s death can constitute major depressive disorder.\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/2aa5fc74-e784-4182-8d6d-d7ebe6c032f6\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/dff42f52-60ff-4316-aeed-81dbf763090d\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/530c5eb2-bf7c-49af-93d7-0dc1a1acfa6a\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/4c8135f4-9558-4d8e-a448-e50e028d146b\r\n\r\n<\/div>\r\n<\/section><section>\r\n<h2>Categories in the DSM<\/h2>\r\nThe DSM-5 is\u00a0<span style=\"font-size: 1em;\">divided into 22 chapters that include sets of related disorders<\/span><span style=\"font-size: 1rem; text-align: initial;\">. This\u00a0organization\u00a0is evident in every chapter\u00a0<\/span><span style=\"font-size: 1em;\">so that related disorders appear closer to each other,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">and p<\/span><span style=\"font-size: 1em;\">sychological and biological diseases often relate to each other.\u00a0<\/span><span style=\"font-size: 1em;\">However, if an illness that is primarily medical is not specified in<em>\u00a0<\/em><\/span>DSM-5<i style=\"font-size: 1em;\">,<\/i><span style=\"font-size: 1em;\">\u00a0clinicians may use the current <\/span><em>ICD<\/em><span style=\"font-size: 1em;\">\u00a0diagnoses to specify the condition.\u00a0<\/span>\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\nView <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Psychology\/APA_DSM-5-Contents+(2).pdf\" target=\"_blank\" rel=\"noopener\">the DSM-5 Table of Contents here<\/a>. Note that the overall outline is the same in the DSM-5-TR, though the contents and some of the language have changed slightly. For example, \"dysthymia\" is no longer used to describe \"persistent depressive disorder,\" the terminology for \"intellectual disability\" has been replaced with \"intellectual development disorder\" and\u00a0\"conversion disorder\" is better known as \"functional neurological symptom disorder.\" A new disorder, prolonged grief disorder, was added to the section on trauma- and stressor-related disorders.\r\n\r\n<\/div>\r\nThe current organization of the DSM-5 begins with neurodevelopmental disorders and then proceeds through <strong>i<\/strong><b>nternalizing problems<\/b>\u00a0(depression, anxiety, social anxiety, somatic complaints, post-traumatic symptoms, and obsession-compulsion) to <strong>externalizing problems\u00a0<\/strong>(disruptive, impulse-control, conduct disorders\u00a0<span style=\"font-size: 1em;\">and substance use,\u00a0<\/span><span style=\"font-size: 1em;\">etc.).\u00a0<\/span><span style=\"font-size: 1em;\">[footnote]Salavera, Carlos, Us\u00e1n, Pablo, &amp; Teruel, Pilar. (2019). The relationship of internalizing problems with emotional intelligence and social skills in secondary education students: gender differences. Psicologia: Reflex\u00e3o e Cr\u00edtica, 32, 4. Epub February 18, 2019. https:\/\/dx.doi.org\/10.1186\/s41155-018-0115-y[\/footnote]<\/span>\r\n\r\n<span style=\"font-size: 1rem; text-align: initial;\">We have organized this course according to the\u00a0DSM-5 and devote time in each of the modules to discuss the main features of mental disorders from each of the DSM-5 categories<i>.<\/i>\u00a0Throughout these modules, you will learn the basic diagnostic criteria, the etiology (causes), epidemiology (prevalence), and treatment options for each category of disorders. In this way, you can gain a basic understanding of each category of mental disorders, including all of the following:<\/span>\r\n<ol>\r\n \t<li>neurodevelopmental disorders<\/li>\r\n \t<li>schizophrenia spectrum and other psychotic disorders<\/li>\r\n \t<li>bipolar and related disorders<\/li>\r\n \t<li>depressive disorders<\/li>\r\n \t<li>anxiety disorders<\/li>\r\n \t<li>obsessive-compulsive and related disorders<\/li>\r\n \t<li>trauma- and stressor-related disorders<\/li>\r\n \t<li>dissociative disorders<\/li>\r\n \t<li>somatic symptom and related disorders<\/li>\r\n \t<li>feeding and eating disorders<\/li>\r\n \t<li>elimination disorders<\/li>\r\n \t<li>sleep-wake disorders<\/li>\r\n \t<li>sexual dysfunctions<\/li>\r\n \t<li>gender dysphoria<\/li>\r\n \t<li>disruptive, impulse-control, and conduct disorders<\/li>\r\n \t<li>substance-related and addictive disorders<\/li>\r\n \t<li>neurocognitive disorders<\/li>\r\n \t<li>personality disorders<\/li>\r\n \t<li>paraphilic disorders<\/li>\r\n \t<li>Other mental disorders[footnote]Regier, D. A., Kuhl, E. A., &amp; Kupfer, D. J. (2013). The <em>DSM-5<\/em>: Classification and criteria changes. <em>World psychiatry: official journal of the World Psychiatric Association<\/em> (WPA), 12(2), 92\u201398. https:\/\/doi.org\/10.1002\/wps.20050[\/footnote]<\/li>\r\n<\/ol>\r\n<\/section>\r\n<h3>Overview of the Major Disorder categories<\/h3>\r\n<section><\/section><section><\/section><section><\/section><section>In this course, the major disorders categories begin with <strong>anxiety disorders<\/strong>.\u00a0Any anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.\u00a0Commonly recognized categories include specific phobias: a specific unrealistic fear; social anxiety disorder: extreme fear and avoidance of social situations;\u00a0panic disorder: suddenly overwhelmed by panic even though there is no apparent reason to be frightened; agoraphobia: an intense fear and avoidance of situations in which it might be difficult to escape; and generalized anxiety disorder:\u00a0a relatively continuous state of tension, apprehension, and dread.\u00a0<\/section><section><\/section><section><\/section><section><\/section><section><\/section><section><\/section><span style=\"font-size: 1em;\">Another module deals with obsessive-compulsive and related disorders and trauma- and stressor-related disorders.\u00a0While similar to anxiety disorders, obsessive-compulsive disorders and posttraumatic stress disorders now have their own distinct categories of classification within the DSM-5 because symptoms of anxiety are not necessarily present. With\u00a0<\/span><strong style=\"font-size: 1em;\">obsessive-compulsive disorder<\/strong><span style=\"font-size: 1em;\">, a person is obsessed with unwanted, unpleasant thoughts and\/or compulsively engages in repetitive behaviors or mental acts, perhaps as a way of coping with the obsessions.\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">Post-traumatic stress disorder is a similar\u00a0disorder, although classified as a trauma- and stressor-related disorder.<\/span>\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\nLearn more about each of the psychological disorders through the <a href=\"https:\/\/www.nimh.nih.gov\/index.shtml\" target=\"_blank\" rel=\"noopener\">National Institute of Mental Health<\/a>.\r\n\r\nOr for an interesting application of the various mental disorders, take a look at this <a href=\"https:\/\/www.youtube.com\/playlist?list=PL81C8C21394E2A94D\" target=\"_blank\" rel=\"noopener\">YouTube playlist showing disorders as they are characterized in popular media<\/a>. These case studies were developed by students in Dr. Caleb Lack's psychology class.\r\n\r\n<\/div>\r\n<strong>Post-traumatic stress disorder<\/strong>\u00a0is a disorder in which the experience of a traumatic or profoundly stressful event, such as combat, sexual assault, or natural disaster, produces a constellation of symptoms that must last for one month or more. These symptoms include intrusive and distressing memories of the event, flashbacks, avoidance of stimuli or situations that are connected to the event, persistently negative emotional states, feeling detached from others, irritability, proneness toward outbursts, and a tendency to be easily startled.\r\n\r\nIn another module, we discuss dissociative disorders, somatic symptom, and related disorders. The main characteristics of <strong>dissociative disorders<\/strong> are that people become dissociated from their sense of self, resulting in memory and identity disturbances. Dissociative disorders listed in the DSM-5 include dissociative amnesia, depersonalization\/derealization disorder, and dissociative identity disorder. A person with dissociative amnesia is unable to recall important personal information, often after a stressful or traumatic experience.\u00a0Depersonalization\/derealization disorder is characterized by recurring episodes of depersonalization (i.e., detachment from or unfamiliarity with the self) and\/or derealization (i.e., detachment from or unfamiliarity with the world). A person with dissociative identity disorder exhibits two or more well-defined and distinct personalities or identities, as well as memory gaps for the time during which another identity was present.\u00a0Dissociative identity disorder has generated controversy, mainly because some believe its symptoms can be faked by patients if presenting its symptoms somehow benefits the patient in avoiding negative consequences or taking responsibility for one\u2019s actions. The diagnostic rates of this disorder have increased dramatically following its portrayal in popular culture. However, many people legitimately suffer over the course of a lifetime with this disorder.\r\n\r\n<strong>Somatic symptom disorders<\/strong> were previously known as \"somataform disorders.\" These include\u00a0somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder (conversion disorder), and fictitious disorder. You will read about the various symptoms, epidemiology, how individuals present with these problems, and a brief overview of possible causes. These disorders relate to a person experiencing physical ailments that are not fully explained by a medical condition.\r\n\r\n<span style=\"font-size: 1rem; text-align: initial;\"><strong>Mood disorders<\/strong> are discussed in another module.\u00a0A mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as <\/span>major depressive disorder<span style=\"font-size: 1rem; text-align: initial;\">.\u00a0Milder but still prolonged depression can be diagnosed as persistent depressive disorder. <\/span>Bipolar disorder<span style=\"font-size: 1rem; text-align: initial;\"> is characterized by mood states that vacillate between sadness and euphoria; a diagnosis of bipolar disorder requires experiencing at least one manic episode, which is defined as a period of extreme euphoria, irritability, and increased activity. Mood disorders appear to have a genetic component, with genetic factors playing a more prominent role in bipolar disorder than in depression. Both biological and psychological factors are important in the development of depression. People who suffer from mental health problems, especially mood disorders, are at heightened risk for suicide.<\/span>\r\n\r\nNext, we discuss feeding and eating disorders. Disordered eating can have significant health consequences, and<strong>\u00a0eating disorders<\/strong> are a major health concern. Anorexia nervosa is an eating disorder characterized by the maintenance of a bodyweight well below average through starvation and\/or excessive exercise. Individuals suffering from anorexia nervosa often have a distorted body image, referenced in literature as a type of body dysmorphia, meaning that they view themselves as overweight even though they are not. People suffering from bulimia nervosa engage in binge eating behavior that is followed by an attempt to compensate for a large amount of consumed food.\u00a0Avoidant\/restrictive food intake disorder\u00a0is an eating or feeding disturbance associated with an apparent lack of interest in eating or food. Pica is a disorder characterized by an appetite for substances that are largely non-nutritive, such as ice, soap, hair, paper, metal, soil, stones, glass, or chalk.\r\n\r\nMany people experience disturbances in their sleep at some point in their lives.\u00a0<strong>Sleep-<\/strong><strong>wake disorders\u00a0<\/strong>involve problems with the quality, timing, and amount of\u00a0sleep, which result in daytime distress and impairment in functioning.\u00a0Sleep-wake disorders\u00a0often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive\u00a0disorders.\r\n\r\n<strong>Substance<\/strong>-<strong>related disorders<\/strong>\u00a0are discussed in a separate module. They result when\u00a0a craving for, the development of, a tolerance to, and difficulties in controlling the use of a particular\u00a0substance or a combination of different substances, as well as withdrawal syndromes when a person ceases to use the\u00a0substance(s). Other addictive disorders also include gambling disorder\u00a0and other behavioral addictions.\r\n\r\nNext, we cover the topics of <strong>gender dysphoria, paraphilic disorders, <\/strong>and<strong> sexual dysfunctions<\/strong>. Today more than ever before, mental health professionals are\u00a0seeing patients seeking treatment in response to dissatisfaction with\u00a0their sexual functioning. Such dissatisfaction most commonly stems\u00a0from a sexual dysfunction, but may also be the result of a sexual deviation. Sexual<span style=\"font-size: 1em;\">\u00a0dysfunction disorders include sexual desire disorders,\u00a0arousal disorders,\u00a0orgasm disorders, and\u00a0pain disorders.\u00a0<\/span><span style=\"font-size: 1em;\">From a clinical perspective,\u00a0there has been some effort to define\u00a0<\/span>sexual deviation<span style=\"font-size: 1em;\">\u00a0under the umbrella of sexual paraphilias. Dissatisfaction can also stem from g<\/span>ender dysphoria, or the distress a person feels due to a mismatch between their\u00a0gender identity\u00a0and their sex assigned at birth.\r\n\r\nThe\u00a0DSM-5\u00a0classifies <strong>psychotic disorders<\/strong>\u00a0that involve psychosis, or a break in reality, like in schizophrenia, delusional disorder, brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, substance\/medication-induced psychotic disorder, and psychotic disorder due to another medical condition. The most common psychotic disorder in this domain is schizophrenia, which is a severe disorder characterized by delusions and hallucinations, often causing a breakdown in one\u2019s ability to function in life.\r\n\r\nThe DSM-5 recognizes 10\u00a0<strong>personality disorders<\/strong>, organized into three clusters. The disorders in Cluster A include those characterized by a personality style that is odd and eccentric. These include paranoid, schizoid, and schizotypal personality disorders. Cluster B includes personality disorders characterized chiefly by a personality style that is impulsive, dramatic, highly emotional, and erratic (antisocial, histrionic, narcissistic, and\u00a0borderline), and those in Cluster C are characterized by a nervous and fearful personality style (avoidant, dependent, and obsessive-compulsive).\r\n\r\n<strong>Neurodevelopmental disorders<\/strong> are covered in another module, along with <strong>elimination disorders<\/strong> and disruptive, impulse-control, and conduct disorders. The neurodevelopmental disorders\u00a0are a group of disorders that are typically diagnosed during childhood and are characterized by developmental deficits in personal, social, academic, and intellectual realms; these disorders include attention-deficit\/hyperactivity disorder (ADHD) and autism spectrum disorder<em>.<\/em>\u00a0<span style=\"font-size: 1em;\">The major features of autism spectrum disorder include deficits in social interaction and communication and repetitive movements or interests.\u00a0<\/span><span style=\"font-size: 1em;\">ADHD is characterized by a pervasive pattern of inattention and\/or hyperactive and impulsive behavior that interferes with normal functioning. Genetic and neurobiological factors contribute to the development of ADHD, which can persist well into adulthood and is often associated with poor, long-term outcomes.\u00a0<\/span>\r\n\r\n<strong>Disruptive<\/strong>,\u00a0<strong>impulse<\/strong>-<strong>control, and conduct disorders<\/strong>\u00a0refer to a group of\u00a0disorders\u00a0that include oppositional defiant\u00a0disorder,\u00a0conduct disorder, intermittent explosive\u00a0disorder, kleptomania, and pyromania. These\u00a0disorders\u00a0can cause people to behave angrily or aggressively toward people or property.\r\n\r\nFinally, we learn about <strong>neurocognitive<\/strong><strong> disorders<\/strong>\u2014disorders\u00a0that describe decreased mental function due to a medical disease other than a psychiatric\u00a0illness. It is often used synonymously (but incorrectly) with dementia. Although <strong>Alzheimer's disease<\/strong> accounts for the majority of cases of neurocognitive disorders, several other conditions can similarly affect\u00a0memory, thinking and reasoning, and the motor system. In addition to Alzheimer's, these conditions include frontotemporal degeneration, Huntington\u2019s disease,\u00a0Lewy body\u00a0disease,\u00a0traumatic brain injury\u00a0(TBI), Parkinson\u2019s disease, prion disease, and dementia\/neurocognitive issues due to HIV infection.\r\n\r\n<section>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/83977fe5-f477-4918-895e-7aca106b9244\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/13026f83-e74f-4f16-8f74-1add22d66033\r\n\r\n<\/div>\r\n<\/section><section><section>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>comorbidity:\u00a0<\/strong>co-occurrence of two disorders in the same individual\r\n\r\n<strong>diagnosis:\u00a0<\/strong>determination of which disorder a set of symptoms represents\r\n\r\n<strong><em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition<\/em> (DSM-5):\u00a0<\/strong>authoritative index of mental disorders and the criteria for their diagnosis; published by the American Psychiatric Association (APA)\r\n\r\n<span style=\"font-size: 0.9em;\"><strong>externalizing problems:<\/strong> problems\u00a0related to disruptive behavior that cause conflicts in relationships with others<\/span>\r\n\r\n<strong>internalizing problems: <\/strong>problems that involve emotional alterations of anxiety disorders and depression\r\n\r\n<\/div>\r\n<\/section><\/section>","rendered":"<div>\n<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe the basic features of the <em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition<\/em> (DSM-5) and how it is used to classify disorders<\/li>\n<li>Outline the major disorder categories of the DSM-5<\/li>\n<\/ul>\n<\/div>\n<p>A first step in the study of mental disorders is carefully and systematically discerning significant signs and symptoms. How do mental health professionals ascertain whether or not a person\u2019s inner states and behaviors truly represent a psychological disorder? Arriving at a proper <strong>diagnosis<\/strong>\u2014that is, appropriately identifying and labeling a set of defined symptoms\u2014is absolutely crucial. This process enables professionals to use a common language with others in the field and aids in communication about the disorder with the patient, colleagues, and the public. A proper diagnosis is an essential element to guide proper and successful treatment. For these reasons, classification systems that organize psychological disorders systematically are necessary.<\/p>\n<\/div>\n<section>\n<h2><em>Diagnostic and Statistical Manual of Mental Disorders<\/em> (DSM-5)<\/h2>\n<p>Although a number of classification systems have been developed over time, the one that is used by most mental health professionals in the United States is the <strong><em>Diagnostic and Statistical Manual of Mental Disorders<\/em> (DSM-5)<\/strong>, published by the American Psychiatric Association in 2013. Additions and revisions were made in March 2022, so the most current edition is called the <em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision<\/em> (DSM-5-TR). (Note that the American Psychiatric Association differs from the American Psychological Association; both are abbreviated APA.) This textbook includes the updates from the DSM-5-TR, though we typically continue to reference the diagnostic manual simply as the DSM-5.<\/p>\n<p>The first edition of the <em>DSM<\/em>, published in 1952, classified psychological disorders according to a format developed by the U.S. Army during World War II (Clegg, 2012). In the years since, the DSM has undergone numerous revisions and editions. The DSM-5 includes many categories of disorders (e.g., anxiety disorders, depressive disorders, and dissociative disorders). Each disorder is described in detail, including an overview of the disorder (diagnostic features), specific symptoms required for diagnosis (diagnostic criteria), <strong>prevalence\u00a0<\/strong>information (what percent of the population is thought to be afflicted with the disorder), and risk factors associated with the disorder. Figure 1\u00a0shows lifetime prevalence rates\u2014the percentage of people in a population who develop a disorder in their lifetime\u2014of various psychological disorders among U.S. adults. These data were based on a national sample of 9,282 U.S. residents (National Comorbidity Survey, 2007).<\/p>\n<figure>\n<div style=\"width: 726px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225103\/CNX_Psych_15_02_Disorders.jpg\" alt=\"A bar graph has an x-axis labeled \u201cDSM disorder\u201d and a y-axis labeled \u201cLifetime prevalence rates.\u201d For each disorder, a prevalence rate is given for total population, females, and males. Appropriate alternative text can be found in the data table displayed below this image. The approximate data shown is: \u201cmajor depressive disorder\u201d 17% total, 20% females, 13% males; \u201calcohol abuse\u201d 13% total, 7% females, 20% males; \u201cspecific phobia\u201d 13% total, 16% females, 8% males; \u201csocial anxiety disorder\u201d 12% total, 13% females, 11% males; \u201cdrug abuse\u201d 8% total, 5% females, 12% males; \u201cposttraumatic stress disorder\u201d 7% total, 10% females, 3% males; \u201cgeneralized anxiety disorder\u201d 6% total, 7% females, 4% males; \u201cpanic disorder\u201d 5% total, 6% females, 3% males; \u201cobsessive-compulsive disorder\u201d 3% total, 3% females, 2% males; \u201cdysthymia\u201d 3% total, 3% females, 2% males.\" width=\"716\" height=\"427\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1<\/strong>. The graph shows the breakdown of psychological disorders, comparing the percentage prevalence among adult males and adult females in the United States. Because the data is from 2007, the categories shown here are from the <em>DSM-4<\/em>, which has been supplanted by the DSM-5. Most categories remain the same; however, alcohol abuse now falls under a broader alcohol use disorder category.<\/p>\n<\/div>\n<\/figure>\n<table>\n<caption>Table 1. <em>DSM<\/em> Disorder Lifetime Prevalence Rates<\/caption>\n<tbody>\n<tr>\n<th scope=\"col\"><em>DSM<\/em> Disorder<\/th>\n<th scope=\"col\">Total<\/th>\n<th scope=\"col\">Females<\/th>\n<th scope=\"col\">Males<\/th>\n<\/tr>\n<tr>\n<th scope=\"row\">Major Depressive Disorder<\/th>\n<td>17%<\/td>\n<td>20%<\/td>\n<td>13%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Alcohol Abuse<\/th>\n<td>13%<\/td>\n<td>7%<\/td>\n<td>20%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Specific Phobia<\/th>\n<td>13%<\/td>\n<td>16%<\/td>\n<td>8%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Social Anxiety Disorder<\/th>\n<td>12%<\/td>\n<td>13%<\/td>\n<td>11%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Drug Abuse<\/th>\n<td>8%<\/td>\n<td>5%<\/td>\n<td>12%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Post-Traumatic Stress Disorder<\/th>\n<td>7%<\/td>\n<td>10%<\/td>\n<td>3%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Generalized Anxiety Disorder<\/th>\n<td>6%<\/td>\n<td>7%<\/td>\n<td>4%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Panic Disorder<\/th>\n<td>5%<\/td>\n<td>6%<\/td>\n<td>3%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Obsessive-Compulsive Disorder<\/th>\n<td>3%<\/td>\n<td>3%<\/td>\n<td>2%<\/td>\n<\/tr>\n<tr>\n<th scope=\"row\">Persistent Depressive Disorder<\/th>\n<td>3%<\/td>\n<td>3%<\/td>\n<td>2%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>More recent data shows that the most prevalent disorders at any given time (not over a lifetime) are anxiety disorders, as shown in the following chart.<a class=\"footnote\" title=\"Hannah Ritchie and Max Roser (2018) - &quot;Mental Health&quot;. Published online at OurWorldInData.org. Retrieved from: 'https:\/\/ourworldindata.org\/mental-health' [Online Resource]\" id=\"return-footnote-56-1\" href=\"#footnote-56-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<div id=\"attachment_5164\" style=\"width: 725px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5164\" class=\"wp-image-5164\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/18220658\/prevalence-by-mental-and-substance-use-disorder.png\" alt=\"Prevalence by mental and substance use disorder (2017). Data shows anxiety disorders as most prevalent at 6.64%, depression 4.84%, drug use 3.45%, alcohol use at 2.04%, bipolar 0.65%, eating disorders 0.51%, and schizophrenia 0.33%.\" width=\"715\" height=\"505\" \/><\/p>\n<p id=\"caption-attachment-5164\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. The prevalence of mental and substance use disorders in the United States.<\/p>\n<\/div>\n<p>The DSM-5 also provides information about <strong>comorbidity<\/strong>; the co-occurrence of two disorders. For example, the DSM-5 mentions that 41% of people with obsessive-compulsive disorder (OCD) also meet the diagnostic criteria for major depressive disorder (Figure 2). Drug use is highly comorbid with other mental illnesses; six out of 10 people who have a substance use disorder also suffer from another form of mental illness (National Institute on Drug Abuse [NIDA], 2007).<\/p>\n<figure>\n<div style=\"width: 497px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225104\/CNX_Psych_15_02_Comorbidity.jpg\" alt=\"A Venn-diagram shows two overlapping circles. One circle is titled \u201cObsessive-Compulsive Disorder\u201d and the other is titled \u201cMajor Depressive Disorder.\u201d The area in which these two circles overlap includes forty-one percent of each circle. This area is titled \u201cComorbidity 41%.\u201d\" width=\"487\" height=\"337\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 3<\/strong>. Obsessive-compulsive disorder and major depressive disorder frequently occur in the same person.<\/p>\n<\/div>\n<\/figure>\n<div class=\"textbox key-takeaways\">\n<h3><span class=\"os-subtitle-label\">Comorbidity<\/span><\/h3>\n<p id=\"zip-idm201856864\">Co-occurrence and comorbidity of psychological disorders are quite common, and some of the most pervasive comorbidities involve substance use disorders that co-occur with psychological disorders. Indeed, some estimates suggest that around a quarter of people who suffer from the most severe cases of mental illness exhibit substance use disorder as well. Conversely, around 10 % of individuals seeking treatment for substance use disorder have serious mental illnesses. Observations such as these have important implications for treatment options that are available. When people with a mental illness are also habitual drug users, their symptoms can be exacerbated and resistant to treatment. Furthermore, it is not always clear whether the symptoms are due to drug use, the mental illness, or a combination of the two. Therefore, it is recommended that behavior is observed in situations in which the individual has ceased using drugs and is no longer experiencing withdrawal from the drug in order to make the most accurate diagnosis (NIDA, 2018).<\/p>\n<p id=\"zip-idm500780704\">Obviously, substance use disorders are not the only possible comorbidities. In fact, some of the most common psychological disorders tend to co-occur. For instance, more than half of individuals who have a primary diagnosis of depressive disorder are estimated to exhibit some sort of anxiety disorder. The reverse is also true for those diagnosed with a primary diagnosis of an anxiety disorder. Further, anxiety disorders and major depression have a high rate of comorbidity with several other psychological disorders (Al-Asadi, Klein, &amp; Meyer, 2015).<\/p>\n<\/div>\n<p>The DSM has changed considerably in the half-century since it was originally published. The first two editions of the <em>DSM<\/em>, for example, listed homosexuality as a disorder; however, in 1973, the APA voted to remove it from the manual (Silverstein, 2009). While the <em>DSM-3<\/em> did not list homosexuality as a disorder, it introduced a new diagnosis, ego-dystonic homosexuality, which emphasized homosexual arousal that the patient viewed as interfering with desired heterosexual relationships and causing distress for the individual. This new diagnosis was considered by many as a compromise to appease those who viewed homosexuality as a mental illness. Other professionals questioned how appropriate it was to have a separate diagnosis that described the content of an individual&#8217;s distress. In 1986, the diagnosis was removed from the <em>DSM-3-R<\/em> (Herek, 2012).<\/p>\n<div class=\"textbox examples\">\n<h3>WAtch It<\/h3>\n<p>This video provides an overview of some of the history related to the development and evolution of the <em>DSM<\/em>.<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"We Were Super Wrong About Mental Illness: The DSM&#39;s Origin Story\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/UiY6wr--0dE?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/WeWereSuperWrongAboutMentalIllness_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;We Were Super Wrong About Mental Illness: The DSM&#8217;s Origin Story&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<p>Additionally, beginning with the <em>DSM-3<\/em> in 1980, mental disorders have been described in much greater detail, and the number of diagnosable conditions has grown steadily, as has the size of the manual itself. DSM-1 included 106 diagnoses and was 130 total pages, whereas <em>DSM-3<\/em> included more than twice as many diagnoses (265) and was nearly seven times its size (886 total pages) (Mayes &amp; Horowitz, 2005). Although DSM-5 is longer than <em>DSM-4<\/em>, the volume includes only 237 disorders, a decrease from the 297 disorders that were listed in <em>DSM-4<\/em>. The DSM-5, includes revisions in the organization and naming of categories and in the diagnostic criteria for various disorders (Regier, Kuhl, &amp; Kupfer, 2012), while emphasizing careful consideration of the importance of gender and cultural difference in the expression of various symptoms (Fisher, 2010). The most recent<\/p>\n<p>Some believe that establishing new diagnoses might over-pathologize the human condition by turning common human problems into mental illnesses (The Associated Press, 2013). Indeed, the finding that nearly half of all Americans will meet the criteria for a <em>DSM<\/em> disorder at some point in their life (Kessler et al., 2005) likely fuels much of this skepticism. The DSM-5 is also criticized on the grounds that its diagnostic criteria have been loosened, thereby threatening to \u201cturn our current diagnostic inflation into diagnostic hyperinflation\u201d (Frances, 2012, para. 22). For example, <em>DSM-4<\/em> specified that the symptoms of major depressive disorder must not be attributable to normal bereavement (loss of a loved one). The DSM-5, however, removed this bereavement exclusion, essentially meaning that grief and sadness after a loved one\u2019s death can constitute major depressive disorder.<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_2aa5fc74-e784-4182-8d6d-d7ebe6c032f6\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/2aa5fc74-e784-4182-8d6d-d7ebe6c032f6?iframe_resize_id=assessment_practice_id_2aa5fc74-e784-4182-8d6d-d7ebe6c032f6\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_dff42f52-60ff-4316-aeed-81dbf763090d\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/dff42f52-60ff-4316-aeed-81dbf763090d?iframe_resize_id=assessment_practice_id_dff42f52-60ff-4316-aeed-81dbf763090d\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_530c5eb2-bf7c-49af-93d7-0dc1a1acfa6a\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/530c5eb2-bf7c-49af-93d7-0dc1a1acfa6a?iframe_resize_id=assessment_practice_id_530c5eb2-bf7c-49af-93d7-0dc1a1acfa6a\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_4c8135f4-9558-4d8e-a448-e50e028d146b\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/4c8135f4-9558-4d8e-a448-e50e028d146b?iframe_resize_id=assessment_practice_id_4c8135f4-9558-4d8e-a448-e50e028d146b\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<\/section>\n<section>\n<h2>Categories in the DSM<\/h2>\n<p>The DSM-5 is\u00a0<span style=\"font-size: 1em;\">divided into 22 chapters that include sets of related disorders<\/span><span style=\"font-size: 1rem; text-align: initial;\">. This\u00a0organization\u00a0is evident in every chapter\u00a0<\/span><span style=\"font-size: 1em;\">so that related disorders appear closer to each other,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">and p<\/span><span style=\"font-size: 1em;\">sychological and biological diseases often relate to each other.\u00a0<\/span><span style=\"font-size: 1em;\">However, if an illness that is primarily medical is not specified in<em>\u00a0<\/em><\/span>DSM-5<i style=\"font-size: 1em;\">,<\/i><span style=\"font-size: 1em;\">\u00a0clinicians may use the current <\/span><em>ICD<\/em><span style=\"font-size: 1em;\">\u00a0diagnoses to specify the condition.\u00a0<\/span><\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p>View <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Psychology\/APA_DSM-5-Contents+(2).pdf\" target=\"_blank\" rel=\"noopener\">the DSM-5 Table of Contents here<\/a>. Note that the overall outline is the same in the DSM-5-TR, though the contents and some of the language have changed slightly. For example, &#8220;dysthymia&#8221; is no longer used to describe &#8220;persistent depressive disorder,&#8221; the terminology for &#8220;intellectual disability&#8221; has been replaced with &#8220;intellectual development disorder&#8221; and\u00a0&#8220;conversion disorder&#8221; is better known as &#8220;functional neurological symptom disorder.&#8221; A new disorder, prolonged grief disorder, was added to the section on trauma- and stressor-related disorders.<\/p>\n<\/div>\n<p>The current organization of the DSM-5 begins with neurodevelopmental disorders and then proceeds through <strong>i<\/strong><b>nternalizing problems<\/b>\u00a0(depression, anxiety, social anxiety, somatic complaints, post-traumatic symptoms, and obsession-compulsion) to <strong>externalizing problems\u00a0<\/strong>(disruptive, impulse-control, conduct disorders\u00a0<span style=\"font-size: 1em;\">and substance use,\u00a0<\/span><span style=\"font-size: 1em;\">etc.).\u00a0<\/span><span style=\"font-size: 1em;\"><a class=\"footnote\" title=\"Salavera, Carlos, Us\u00e1n, Pablo, &amp; Teruel, Pilar. (2019). The relationship of internalizing problems with emotional intelligence and social skills in secondary education students: gender differences. Psicologia: Reflex\u00e3o e Cr\u00edtica, 32, 4. Epub February 18, 2019. https:\/\/dx.doi.org\/10.1186\/s41155-018-0115-y\" id=\"return-footnote-56-2\" href=\"#footnote-56-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/span><\/p>\n<p><span style=\"font-size: 1rem; text-align: initial;\">We have organized this course according to the\u00a0DSM-5 and devote time in each of the modules to discuss the main features of mental disorders from each of the DSM-5 categories<i>.<\/i>\u00a0Throughout these modules, you will learn the basic diagnostic criteria, the etiology (causes), epidemiology (prevalence), and treatment options for each category of disorders. In this way, you can gain a basic understanding of each category of mental disorders, including all of the following:<\/span><\/p>\n<ol>\n<li>neurodevelopmental disorders<\/li>\n<li>schizophrenia spectrum and other psychotic disorders<\/li>\n<li>bipolar and related disorders<\/li>\n<li>depressive disorders<\/li>\n<li>anxiety disorders<\/li>\n<li>obsessive-compulsive and related disorders<\/li>\n<li>trauma- and stressor-related disorders<\/li>\n<li>dissociative disorders<\/li>\n<li>somatic symptom and related disorders<\/li>\n<li>feeding and eating disorders<\/li>\n<li>elimination disorders<\/li>\n<li>sleep-wake disorders<\/li>\n<li>sexual dysfunctions<\/li>\n<li>gender dysphoria<\/li>\n<li>disruptive, impulse-control, and conduct disorders<\/li>\n<li>substance-related and addictive disorders<\/li>\n<li>neurocognitive disorders<\/li>\n<li>personality disorders<\/li>\n<li>paraphilic disorders<\/li>\n<li>Other mental disorders<a class=\"footnote\" title=\"Regier, D. A., Kuhl, E. A., &amp; Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World psychiatry: official journal of the World Psychiatric Association (WPA), 12(2), 92\u201398. https:\/\/doi.org\/10.1002\/wps.20050\" id=\"return-footnote-56-3\" href=\"#footnote-56-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/li>\n<\/ol>\n<\/section>\n<h3>Overview of the Major Disorder categories<\/h3>\n<section><\/section>\n<section><\/section>\n<section><\/section>\n<section>In this course, the major disorders categories begin with <strong>anxiety disorders<\/strong>.\u00a0Any anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.\u00a0Commonly recognized categories include specific phobias: a specific unrealistic fear; social anxiety disorder: extreme fear and avoidance of social situations;\u00a0panic disorder: suddenly overwhelmed by panic even though there is no apparent reason to be frightened; agoraphobia: an intense fear and avoidance of situations in which it might be difficult to escape; and generalized anxiety disorder:\u00a0a relatively continuous state of tension, apprehension, and dread.\u00a0<\/section>\n<section><\/section>\n<section><\/section>\n<section><\/section>\n<section><\/section>\n<section><\/section>\n<p><span style=\"font-size: 1em;\">Another module deals with obsessive-compulsive and related disorders and trauma- and stressor-related disorders.\u00a0While similar to anxiety disorders, obsessive-compulsive disorders and posttraumatic stress disorders now have their own distinct categories of classification within the DSM-5 because symptoms of anxiety are not necessarily present. With\u00a0<\/span><strong style=\"font-size: 1em;\">obsessive-compulsive disorder<\/strong><span style=\"font-size: 1em;\">, a person is obsessed with unwanted, unpleasant thoughts and\/or compulsively engages in repetitive behaviors or mental acts, perhaps as a way of coping with the obsessions.\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">Post-traumatic stress disorder is a similar\u00a0disorder, although classified as a trauma- and stressor-related disorder.<\/span><\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p>Learn more about each of the psychological disorders through the <a href=\"https:\/\/www.nimh.nih.gov\/index.shtml\" target=\"_blank\" rel=\"noopener\">National Institute of Mental Health<\/a>.<\/p>\n<p>Or for an interesting application of the various mental disorders, take a look at this <a href=\"https:\/\/www.youtube.com\/playlist?list=PL81C8C21394E2A94D\" target=\"_blank\" rel=\"noopener\">YouTube playlist showing disorders as they are characterized in popular media<\/a>. These case studies were developed by students in Dr. Caleb Lack&#8217;s psychology class.<\/p>\n<\/div>\n<p><strong>Post-traumatic stress disorder<\/strong>\u00a0is a disorder in which the experience of a traumatic or profoundly stressful event, such as combat, sexual assault, or natural disaster, produces a constellation of symptoms that must last for one month or more. These symptoms include intrusive and distressing memories of the event, flashbacks, avoidance of stimuli or situations that are connected to the event, persistently negative emotional states, feeling detached from others, irritability, proneness toward outbursts, and a tendency to be easily startled.<\/p>\n<p>In another module, we discuss dissociative disorders, somatic symptom, and related disorders. The main characteristics of <strong>dissociative disorders<\/strong> are that people become dissociated from their sense of self, resulting in memory and identity disturbances. Dissociative disorders listed in the DSM-5 include dissociative amnesia, depersonalization\/derealization disorder, and dissociative identity disorder. A person with dissociative amnesia is unable to recall important personal information, often after a stressful or traumatic experience.\u00a0Depersonalization\/derealization disorder is characterized by recurring episodes of depersonalization (i.e., detachment from or unfamiliarity with the self) and\/or derealization (i.e., detachment from or unfamiliarity with the world). A person with dissociative identity disorder exhibits two or more well-defined and distinct personalities or identities, as well as memory gaps for the time during which another identity was present.\u00a0Dissociative identity disorder has generated controversy, mainly because some believe its symptoms can be faked by patients if presenting its symptoms somehow benefits the patient in avoiding negative consequences or taking responsibility for one\u2019s actions. The diagnostic rates of this disorder have increased dramatically following its portrayal in popular culture. However, many people legitimately suffer over the course of a lifetime with this disorder.<\/p>\n<p><strong>Somatic symptom disorders<\/strong> were previously known as &#8220;somataform disorders.&#8221; These include\u00a0somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder (conversion disorder), and fictitious disorder. You will read about the various symptoms, epidemiology, how individuals present with these problems, and a brief overview of possible causes. These disorders relate to a person experiencing physical ailments that are not fully explained by a medical condition.<\/p>\n<p><span style=\"font-size: 1rem; text-align: initial;\"><strong>Mood disorders<\/strong> are discussed in another module.\u00a0A mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as <\/span>major depressive disorder<span style=\"font-size: 1rem; text-align: initial;\">.\u00a0Milder but still prolonged depression can be diagnosed as persistent depressive disorder. <\/span>Bipolar disorder<span style=\"font-size: 1rem; text-align: initial;\"> is characterized by mood states that vacillate between sadness and euphoria; a diagnosis of bipolar disorder requires experiencing at least one manic episode, which is defined as a period of extreme euphoria, irritability, and increased activity. Mood disorders appear to have a genetic component, with genetic factors playing a more prominent role in bipolar disorder than in depression. Both biological and psychological factors are important in the development of depression. People who suffer from mental health problems, especially mood disorders, are at heightened risk for suicide.<\/span><\/p>\n<p>Next, we discuss feeding and eating disorders. Disordered eating can have significant health consequences, and<strong>\u00a0eating disorders<\/strong> are a major health concern. Anorexia nervosa is an eating disorder characterized by the maintenance of a bodyweight well below average through starvation and\/or excessive exercise. Individuals suffering from anorexia nervosa often have a distorted body image, referenced in literature as a type of body dysmorphia, meaning that they view themselves as overweight even though they are not. People suffering from bulimia nervosa engage in binge eating behavior that is followed by an attempt to compensate for a large amount of consumed food.\u00a0Avoidant\/restrictive food intake disorder\u00a0is an eating or feeding disturbance associated with an apparent lack of interest in eating or food. Pica is a disorder characterized by an appetite for substances that are largely non-nutritive, such as ice, soap, hair, paper, metal, soil, stones, glass, or chalk.<\/p>\n<p>Many people experience disturbances in their sleep at some point in their lives.\u00a0<strong>Sleep-<\/strong><strong>wake disorders\u00a0<\/strong>involve problems with the quality, timing, and amount of\u00a0sleep, which result in daytime distress and impairment in functioning.\u00a0Sleep-wake disorders\u00a0often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive\u00a0disorders.<\/p>\n<p><strong>Substance<\/strong>&#8211;<strong>related disorders<\/strong>\u00a0are discussed in a separate module. They result when\u00a0a craving for, the development of, a tolerance to, and difficulties in controlling the use of a particular\u00a0substance or a combination of different substances, as well as withdrawal syndromes when a person ceases to use the\u00a0substance(s). Other addictive disorders also include gambling disorder\u00a0and other behavioral addictions.<\/p>\n<p>Next, we cover the topics of <strong>gender dysphoria, paraphilic disorders, <\/strong>and<strong> sexual dysfunctions<\/strong>. Today more than ever before, mental health professionals are\u00a0seeing patients seeking treatment in response to dissatisfaction with\u00a0their sexual functioning. Such dissatisfaction most commonly stems\u00a0from a sexual dysfunction, but may also be the result of a sexual deviation. Sexual<span style=\"font-size: 1em;\">\u00a0dysfunction disorders include sexual desire disorders,\u00a0arousal disorders,\u00a0orgasm disorders, and\u00a0pain disorders.\u00a0<\/span><span style=\"font-size: 1em;\">From a clinical perspective,\u00a0there has been some effort to define\u00a0<\/span>sexual deviation<span style=\"font-size: 1em;\">\u00a0under the umbrella of sexual paraphilias. Dissatisfaction can also stem from g<\/span>ender dysphoria, or the distress a person feels due to a mismatch between their\u00a0gender identity\u00a0and their sex assigned at birth.<\/p>\n<p>The\u00a0DSM-5\u00a0classifies <strong>psychotic disorders<\/strong>\u00a0that involve psychosis, or a break in reality, like in schizophrenia, delusional disorder, brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, substance\/medication-induced psychotic disorder, and psychotic disorder due to another medical condition. The most common psychotic disorder in this domain is schizophrenia, which is a severe disorder characterized by delusions and hallucinations, often causing a breakdown in one\u2019s ability to function in life.<\/p>\n<p>The DSM-5 recognizes 10\u00a0<strong>personality disorders<\/strong>, organized into three clusters. The disorders in Cluster A include those characterized by a personality style that is odd and eccentric. These include paranoid, schizoid, and schizotypal personality disorders. Cluster B includes personality disorders characterized chiefly by a personality style that is impulsive, dramatic, highly emotional, and erratic (antisocial, histrionic, narcissistic, and\u00a0borderline), and those in Cluster C are characterized by a nervous and fearful personality style (avoidant, dependent, and obsessive-compulsive).<\/p>\n<p><strong>Neurodevelopmental disorders<\/strong> are covered in another module, along with <strong>elimination disorders<\/strong> and disruptive, impulse-control, and conduct disorders. The neurodevelopmental disorders\u00a0are a group of disorders that are typically diagnosed during childhood and are characterized by developmental deficits in personal, social, academic, and intellectual realms; these disorders include attention-deficit\/hyperactivity disorder (ADHD) and autism spectrum disorder<em>.<\/em>\u00a0<span style=\"font-size: 1em;\">The major features of autism spectrum disorder include deficits in social interaction and communication and repetitive movements or interests.\u00a0<\/span><span style=\"font-size: 1em;\">ADHD is characterized by a pervasive pattern of inattention and\/or hyperactive and impulsive behavior that interferes with normal functioning. Genetic and neurobiological factors contribute to the development of ADHD, which can persist well into adulthood and is often associated with poor, long-term outcomes.\u00a0<\/span><\/p>\n<p><strong>Disruptive<\/strong>,\u00a0<strong>impulse<\/strong>&#8211;<strong>control, and conduct disorders<\/strong>\u00a0refer to a group of\u00a0disorders\u00a0that include oppositional defiant\u00a0disorder,\u00a0conduct disorder, intermittent explosive\u00a0disorder, kleptomania, and pyromania. These\u00a0disorders\u00a0can cause people to behave angrily or aggressively toward people or property.<\/p>\n<p>Finally, we learn about <strong>neurocognitive<\/strong><strong> disorders<\/strong>\u2014disorders\u00a0that describe decreased mental function due to a medical disease other than a psychiatric\u00a0illness. It is often used synonymously (but incorrectly) with dementia. Although <strong>Alzheimer&#8217;s disease<\/strong> accounts for the majority of cases of neurocognitive disorders, several other conditions can similarly affect\u00a0memory, thinking and reasoning, and the motor system. In addition to Alzheimer&#8217;s, these conditions include frontotemporal degeneration, Huntington\u2019s disease,\u00a0Lewy body\u00a0disease,\u00a0traumatic brain injury\u00a0(TBI), Parkinson\u2019s disease, prion disease, and dementia\/neurocognitive issues due to HIV infection.<\/p>\n<section>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_83977fe5-f477-4918-895e-7aca106b9244\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/83977fe5-f477-4918-895e-7aca106b9244?iframe_resize_id=assessment_practice_id_83977fe5-f477-4918-895e-7aca106b9244\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_13026f83-e74f-4f16-8f74-1add22d66033\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/13026f83-e74f-4f16-8f74-1add22d66033?iframe_resize_id=assessment_practice_id_13026f83-e74f-4f16-8f74-1add22d66033\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<\/section>\n<section>\n<section>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>comorbidity:\u00a0<\/strong>co-occurrence of two disorders in the same individual<\/p>\n<p><strong>diagnosis:\u00a0<\/strong>determination of which disorder a set of symptoms represents<\/p>\n<p><strong><em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition<\/em> (DSM-5):\u00a0<\/strong>authoritative index of mental disorders and the criteria for their diagnosis; published by the American Psychiatric Association (APA)<\/p>\n<p><span style=\"font-size: 0.9em;\"><strong>externalizing problems:<\/strong> problems\u00a0related to disruptive behavior that cause conflicts in relationships with others<\/span><\/p>\n<p><strong>internalizing problems: <\/strong>problems that involve emotional alterations of anxiety disorders and depression<\/p>\n<\/div>\n<\/section>\n<\/section>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-56\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Sonja Ann Miller for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Diagnosing and Classifying Psychological Disorders. <strong>Authored by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:a0DgbqZ1@5\/Diagnosing-and-Classifying-Psy\">http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:a0DgbqZ1@5\/Diagnosing-and-Classifying-Psy<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/content\/col11629\/latest\/.<\/li><li>Mental Health Data. <strong>Authored by<\/strong>: Hannah Ritchie and Max Roser. <strong>Provided by<\/strong>: Our World in Data. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/ourworldindata.org\/mental-health\">https:\/\/ourworldindata.org\/mental-health<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Psychological Disorders: Crash Course Psychology #28. <strong>Provided by<\/strong>: CrashCourse. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=wuhJ-GkRRQc&#038;feature=youtu.be&#038;list=PL8dPuuaLjXtOPRKzVLY0jJY-uHOH9KVU6\">https:\/\/www.youtube.com\/watch?v=wuhJ-GkRRQc&#038;feature=youtu.be&#038;list=PL8dPuuaLjXtOPRKzVLY0jJY-uHOH9KVU6<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-56-1\">Hannah Ritchie and Max Roser (2018) - \"Mental Health\". Published online at OurWorldInData.org. Retrieved from: 'https:\/\/ourworldindata.org\/mental-health' [Online Resource] <a href=\"#return-footnote-56-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-56-2\">Salavera, Carlos, Us\u00e1n, Pablo, &amp; Teruel, Pilar. (2019). The relationship of internalizing problems with emotional intelligence and social skills in secondary education students: gender differences. Psicologia: Reflex\u00e3o e Cr\u00edtica, 32, 4. Epub February 18, 2019. https:\/\/dx.doi.org\/10.1186\/s41155-018-0115-y <a href=\"#return-footnote-56-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-56-3\">Regier, D. A., Kuhl, E. A., &amp; Kupfer, D. J. (2013). The <em>DSM-5<\/em>: Classification and criteria changes. <em>World psychiatry: official journal of the World Psychiatric Association<\/em> (WPA), 12(2), 92\u201398. https:\/\/doi.org\/10.1002\/wps.20050 <a href=\"#return-footnote-56-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":7,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Diagnosing and Classifying Psychological Disorders\",\"author\":\"OpenStax College\",\"organization\":\"\",\"url\":\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:a0DgbqZ1@5\/Diagnosing-and-Classifying-Psy\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/content\/col11629\/latest\/.\"},{\"type\":\"copyrighted_video\",\"description\":\"Psychological Disorders: Crash Course Psychology #28\",\"author\":\"\",\"organization\":\"CrashCourse\",\"url\":\"https:\/\/www.youtube.com\/watch?v=wuhJ-GkRRQc&feature=youtu.be&list=PL8dPuuaLjXtOPRKzVLY0jJY-uHOH9KVU6\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Sonja Ann Miller for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Mental Health Data\",\"author\":\"Hannah Ritchie and Max Roser\",\"organization\":\"Our World in Data\",\"url\":\"https:\/\/ourworldindata.org\/mental-health\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"8fc96ed1-1cca-453c-a4a6-a5e91e30c744, c3b460a3-da6f-41d7-8570-6dfa0d339ff0, 6d94569b-a03b-4878-8682-b9de9b3d8dc0","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-56","chapter","type-chapter","status-publish","hentry"],"part":132,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/56","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":53,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/56\/revisions"}],"predecessor-version":[{"id":7606,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/56\/revisions\/7606"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/132"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/56\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=56"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=56"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=56"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=56"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}