Anxiety, Mood, Dissociation, and Somatoform Disorders Matrix

Anxiety Disorders:  Anxiety disorders are the experience of unrelenting and unpleasant emotions characterized by a sense of danger, extreme concern, and sensations of fear in situations or events that do not warrant such an extreme response (Hansell & Damour, 2008).

Disorder/Classification	Definition
Generalized Anxiety Disorder (GAD)	Generalized anxiety disorder is characterized by chronic, pervasive and debilitating nervousness (Hansell & Damour, 2008).  Individuals with this disorder feel tense and worried most of the time and the worry causes distress and can interfere with normal daily functioning. Research suggests generalized anxiety disorder might have a genetic component.  For many who are diagnosed with this disorder, stress tends to worsen the symptoms.  Generalized anxiety disorder can begin as early as childhood, although the most severe symptoms may manifest more slowly than in some of the other anxiety disorders (Hansell & Damour, 2008).  Sometimes this disorder is a psychological response to an event or a chronic stressor in adulthood.  The anxiety can be chronic for many people but therapeutic intervention from a trained medical professional can help to relieve symptoms, and it can be managed to the extent of having no further symptoms (Hansell & Damour, 2008).
Panic Disorder	Panic disorder causes individuals to experience episodes of intense terror which causes internal turmoil, fear, distress, and often impairment to daily functioning.  Panic attacks are characterized by overwhelming anxiety, fear of death, or need to escape.  These attacks are not at all like the chronic anxiety of generalized anxiety disorder.  Panic attacks are severe episodes of extremely debilitating anxiety.  Sometimes even the thought of having a panic attack will cause people to stay home for fear of triggering an attack.  In its worse forms, panic disorder can have a significant effect on normal functioning (Hansell & Damour, 2008).
Phobias	Phobias are persistent, irrational fears of events, situations, or objects.  According to Hansell and Damour (2008), they are the most common anxiety disorders listed in the DSM-IV-TR.  They are persistent and exaggerated and most people make great effort to avoid the feared object or situation.  Phobias, especially when common objects or situations can be disruptive and inconvenient and can, in its most severe examples, cause difficulty in normal functioning (National Institutes of Health, 2010). Phobias are an extremely strong and irrational fear of something that poses little to no real danger (National Institutes of Health, 2010).
Obsessive-Compulsive Disorder	Obsessive-compulsive disorder is a condition characterized by unwanted repetitive and anxiety -producing thoughts accompanied by the compulsive act of rituals that the individual believes will protect them from the anxiety (Hansell & Damour, 2008).  The obsessions are thoughts or impulses over which the individual has no control except to apply the ritual for relief, and the compulsions make the individual feel driven to do something (usually the ritualistic practice for the purpose of relieving the anxiety (Hansell & Damour, 2008).
Acute Stress Disorder	Acute stress disorder is a significant posttraumatic disorder in which individuals experience severe anxiety within one month of exposure to an overwhelming emotional experience in which there is real or perceived threat for injury or death to themselves or a loved one (Hansell & Damour, 2008). A diagnosis of acute stress disorder is indicated if an individual experiences a range of symptoms that last longer than two days, although less than a month, and co-exists with a feeling of being detached from one's own body  and causes distress and significant impairment to normal functioning (Hansell & Damour, 2008).
Posttraumatic Stress Disorder	Posttraumatic stress disorder is characterized by anxiety symptoms which occur more than one month after experiencing a traumatic event.  Typically a range of stress symptoms continues for longer than a month and may co-exist with a change in mental state.  There are three different types of posttraumatic stress disorder: acute, when stress symptoms are experienced for less than three months; chronic, when symptoms last longer than three months; and delayed onset, when the symptoms of stress are delayed and their onset is six months or longer after the traumatic experience (Hansell & Damour, 2008).

Mood Disorders:  The central symptom in mood disorders is a significant disruption in mood.  Mood disorders are characterized by extreme and intense moods and those that seem inappropriate to the context within which they occur (Hansell & Damour, 2008).

Disorder	Definition
Major Depressive Disorder	Major depressive disorder is also called major depression, unipolar depression, or clinical depression.  This disorder consists of depressive episodes which are severe and continue for extended periods.  When an individual has more than one episode of depression, it is called recurrent major depressive disorder (Hansell & Damour, 2009).  When individuals have a major depressive disorder, they have a characteristically depressed mood and a loss of interest or pleasure in activities which they previously enjoyed (Schimelpfening, 2009).  The depressive symptoms must be constant for at least two weeks. People who have major depression are at a higher risk for suicide, and it is important to determine if an individual might have this tendency as professional medical help can deter such attempts.  All age groups are affected by this disorder, even as young as six months. Symptoms include daily depression, diminished capacity to enjoy normal activities, weight loss or weight gain, insomnia or hypersomnia, agitation, fatigue, feelings of worthlessness or excessive guilt, inability to concentrate, and suicidal ideation.
Dysthymic Disorder (Minor depression)	Dysthymic disorder, also called minor depression, consists of two or more years of consistent depressive symptoms characterized as chronically mild depression, but consistent.  Even though symptoms of dysthymic disorder are not severe enough to meet criteria of major depression, it is debilitating and oppressive for its victims.  Symptoms may include depression, irritability, eating or sleeping disturbances, fatigue, and low self-esteem, and are chronic and persist for long periods.  Individuals with dysthymic disorder may feel withdrawn and ineffective.  They have the potential to experience major depressive episodes which is known as double depression (Hansell & Damour, 2009).  In this case the individual is diagnosed with both disorders simultaneously. Treatments for dysthymia are usually the same as for major depression and include antidepressant medications and psychotherapy.
Bipolar I Disorder	Bipolar disorder is characterized by mood swings that run on a spectrum from mild to severe and alternate between elevated or manic episodes to depression (Schimelpfening, 2007).  The severity can range from mild hypomanias to debilitating manic highs, and these manias can last for hours, days, weeks and even months before depressive symptoms return.  Sometimes the individual can display mixed episodes in which they experience the manic and depressive states simultaneously.  The average for individuals is four mood cycles in the first 10 years of having the disorder.  It is important to receive appropriate medical intervention because the manic and depressive patterns may intensify and occur more frequently over time (Hansell & Damour, 2008). The variation in the way individuals cycle through episodes can range dramatically from having four or more cycles in one year to having no symptoms for many years.  The disorder is highly individualized in the way individuals experience mood cycles, sometimes having several episodes, then none for an extended period of time (Schimelpfening, 2007).
Bipolar II Disorder	Cyclothymic disorder consists of mood swings less severe, although more constant than both bipolar disorders.  In this disorder, mood swings continue for at least two years, and the changes in mood alternates between extremely manic highs and lows with depressive symptoms.  Cyclothymic disorder can worsen over time and15 to 50 percent of people with this disorder may develop bipolar I or II in the future (Hansell & Damour, 2008).
Cyclothymic Disorder	Cyclothymic disorder is a milder form of bipolar disorder in which individuals have mood swings that extend over several years and cycle between mild depression to euphoria and excitement.  The causes of this disorder are unknown, although it may share a genetic component with major depression and bipolar disorder.  Research suggests all three disorders occur among family members so they may share similar causes (Hansell & Damour, 2008).     Cyclothymia usually affects individuals early in life and it affects men and women equally (Pub Med Health, 2010).  Although this condition can advance to bipolar disorder, less than half of the individuals diagnosed will do so.  Cyclothymia will often continue as a chronic disorder, or will disappear at some point (Pub Med Health, 2010).

Dissociation Disorders:   Dissociation disorders are significant disruptions in individual's conscious experience, memory, sense of identity, or a combination of any of the three and without physical cause.  Dissociation disorders disrupt daily normal functioning (Hansell & Damour, 2008).

Disorder/Classification	Definition
Depersonalization Disorder	Dissociative disorders are those in which the individual is affected by feelings of detachment from themselves, or a sense that their environment in unreal, or surreal.  The detachment from one's mental processes or body is persistent and/or recurring.  The individuals may have an out- of-body experience, or feel as if they are in a movie, or that life is like a dream.  They feel disconnected and detached, although are able to distinguish between their own internal experiences and the reality of the world outside them.  As such, this disorder is not considered a psychosis (Hansell & Damour, 2008). Individuals with depersonalization disorder are not a risk to others because even though they have feelings of detachment, they can always distinguish between what is based in reality and what is not (Hansell & Damour, 2008).
Dissociation Amnesia	Dissociative amnesia, formerly called psychogenic amnesia, is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, consciousness or awareness, identity and/or perception.  These symptoms can interfere with a person’s general functioning, including social and work activities, and relationships. Dissociative amnesia occurs when a people block out certain information, usually associated with a stressful or traumatic event, leaving them unable to remember important personal information. With this disorder, the degree of memory loss goes beyond normal forgetfulness and includes gaps in memory for long periods of time or of memories involving the traumatic event. Dissociative amnesia is not the same as simple amnesia, which involves a loss of information from the memory, usually as the result of disease or injury to the brain. With dissociative amnesia, the memories still exist but are deeply buried within the person’s mind and cannot be recalled. However, the memories might resurface on their own or after being triggered by something in the person’s surroundings.
Dissociation Fugue	The main symptom of this condition is the creation of physical distance from your real identity. For example, individuals with this condition may travel abruptly, forgetting who they are, and even creating a new identity somewhere else.  A fugue may last a few hours or even several months and ends as abruptly as it began.  When the fugue ends, the individual may be confused and disoriented and has no idea where they have been, how they arrived, and what they have done during the "lost" time.
Dissociation Identity Disorder	Dissociative identity disorder is a severe form of dissociation, which causes an inability to make normal connections between thoughts, memories, feelings, behaviors, and self-identity.  Psychological science believes dissociative identity disorder has its basis in the experience of severe trauma.  Dissociating is considered a coping mechanism and by dissociating themselves from a situation or experience that is too difficult with which to cope.   By dissociating, the new self copes for the individual (Hansell & Damour, 2008). This disorder involves individuals experiencing at least two identities or personality states, each of which has a consistent personality and temperament.  Some individuals with this disorder demonstrate distinctly different physiological responses such as pulse, blood pressure, and blood flow to the brain (Hansell & Damour, 2008).

Somatoform Disorders:  A group of disorders characterized by physical symptoms that are experienced as part of a medical condition but have no physical or medical basis.  Psychological stress is usually the underlying cause or the reason for the conditions or it exacerbates the symptoms (PsyWeb.com, 2011).

Disorder/Classification	Definition
Somatization Disorder	The level of pain associated with the symptoms can interfere with everyday activities and cause the individual to seek constant medical attention.  Stress can exacerbate symptoms.  In most individuals with this diagnosis, they experience a continual cycle of pain and worry over which they have no control.  Evidence suggests many who have this disorder have experienced physical or sexual abuse, but not all who have somatization disorder have a history of such abuse (Hansell & Damour, 2008).
Undifferentiated Somatoform Disorder	Undifferentiated somatoform disorder is a milder form of somatization disorder that lasts at least six months and is characterized by physical complaints that have no physical basis or medical condition.  When there is an affiliated medical condition, the pain is far more excessive than would ordinarily be associated with such a condition (Hansell & Damour, 2008).
Conversion Disorder	Conversion disorder is a condition in which individuals demonstrate psychological stress in physical ways. The condition was named "conversion" disorder because ordinarily the problem starts as a psychological challenge or emotional crisis, then converts to a physical condition (Hansell & Damour, 2008). In this disorder, an individual's legs may become paralyzed after a fall, even though there is no evidence of physical injury.  Even though the individual's symptoms appear with no apparent physical cause, the symptoms cannot be controlled.
Pain Disorder	Pain disorder causes chronic pain, usually in one or more areas and is caused by psychological stress.  Pain is the primary symptom, yet the main cause is psychological factors, and these factors maintain and exacerbate the condition.  The pain can be severe enough to disable the individual's normal functioning.  The pain can be short-lived for only a few days or it can be chronic, lasting several years.  Women are more prone to this disorder than are men, and it can begin at any age.  Often this disorder happens after an accident or illness that causes pain and the pain seems to take on a life of its own (Hansell & Damour, 2008).
Body Dysmorphic Disorder	Body dysmorphic disorder is a chronic mental illness in which individuals cannot stop thinking about a specific flaw, usually an imagined or minor one, in their appearance.  This disorder has been called imagined ugliness disorder because people diagnosed with this disorder believe their appearance is so distorted or flawed, they do not want to associate with others or be seen in public (Hansell & Damour, 2008). Individuals who have body dysmorphic disorder obsessively dwell on their appearance and body image, for long periods, even for hours at a time.  Some people go to the extent of surgeries to correct their perceived flaws, although they are never satisfied with results.  Sometimes people are extremely fearful about having a deformity, even if they do not have one; they worry about having one later.  This disorder is a debilitating preoccupation with imagined or highly exaggerated defects (Hansell & Damour, 2008).
Hypochondriasis	Hypochondriasis is having a chronic fear of illness even when there is none.  Individuals may experience physical sensations and exaggerate them as a sign of serious illness.  In this condition, there is no medical evidence that a real illness is present.  Individuals who have hypochondria have no control over their concerns, and readily believe any symptom or feeling is a symptom of a serious illness (Pub Med Health, 2010). People with this disorder constantly and regularly seek the help of friends, family, and health care professionals.  Although they might feel better for a while, they will worry about the same symptom again soon, or discover a new symptom with which to concern themselves (Hansell & Damour, 2009).  Symptoms are often vague and changeable.  Individuals with this condition often examine their bodies.  Some understand their fears are unreasonable and unfounded (Pub Med Health, 2010).

References

Hansell, J., & Damour, L. (2008). Abnormal psychology. Hoboken, NJ: Wiley.

National Institutes of Health. (2010). Phobias: MedlinePlus. National Library of Medicine - National Institutes of Health. Retrieved May 12, 2011, from http://www.nlm.nih.gov/medlineplus/phobias.html

PsyWeb.com. (2011). Somatoform Disorders. PSYweb Complete Mental Health Site. Retrieved May 12, 2011, from http://www.psyweb.com/mdisord/jsp/somatd.jsp

PubMed Health. (2010). Cyclothymic disorder. Retrieved May 12, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002517/

PubMed Health. (2010). Hypochondria. PubMed Health. Retrieved May 12, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002216/

Schimelpfening, N. (2007). Bipolar disorder - definition of bipolar disorder. About Depression - Information and Support for Depression. Retrieved May 12, 2011, from http://depression.about.com/od/bipolar/g/bipolardisorder.htm

Schimelpfening, N. (2009). Major depressive disorder - DSM-IV criteria for major depressive disorder. About Depression - Information and Support for Depression. Retrieved May 12, 2011, from http://depression.about.com/cs/diagnosis/a/mdd.htm

Simeon, D., & Abugel, J. (2006). Feeling Unreal: Depersonalization Disorder and the Loss of the Self. New York, NY: Oxford University Press.

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