Phobias, Depression & OCD

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The DSM Classification of Phobias

The Diagnostic and Statistical Manual of Mental Disorders is now in its fifth edition. It is like a medical dictionary; it lists symptoms for mental disorders to aid diagnosis. The ICD 10 (International Classification of Diseases) is similar, but there are differences.

DSM-5 categories of phobias

They are all categorised by excessive fear and anxiety, triggered by an object, place or situation.
The extent of the fear is out of proportion to any real danger presented by the phobic stimulus.
Phobias fall under the classification of ‘anxiety disorders’ – a group of mental disorders that share the primary symptom of extreme anxiety.
They are instances of irrational fears that produce a conscious avoidance of the feared object or situation.

Examples of phobias

Social Phobias
- Agoraphobia – fear of public places, being out of the house
Specific Phobias
- Arachnophobia – spiders
Claustrophobia – enclosed spaces
Acrophobia – heights.

Physical symptoms of phobias

Behavioural characteristics are categorised by avoidance behaviours.
- E.g. if you have a phobia of spiders, you will avoid it.
Sometimes, people freeze or faint. There will be physical symptoms; the fight or flight response.
- E.g. increased heart rate, perspiration etc. will be evident when confronted by the phobic object or situation or even the thought of it.

DSM diagnostic criteria for phobias

Unreasonable, excessive fear
Immediate anxiety response
Recognition that the fear is irrational or that it is not required
Avoidance or extreme distress
Lifestyle limiting
Six months duration
Not caused by another disorder

Depression

Major depressive disorder (MDD) is a mood disorder that causes feelings of extreme sadness and low mood, and can reduce the sufferer's ability to function normally.

Depression symptoms

The defining symptoms of a major depressive disorder include “depressed mood most of the day, nearly every day”, feeling sad, empty or hopeless, and loss of interest in activities that previously brought joy.
Depression is considered episodic: its symptoms are typically present at their full magnitude for a period of time and then gradually reduce.

Depression risks

Around 50% of people who experience an episode will go on to have another in the future, and the more a person has, the likelihood of them having another episode increases.
Depression is also considered a risk factor for various other health conditions, including heart attacks, anxiety disorders, obesity, substance abuse, and more.

Behavioural characteristics of depression

Difficulty falling asleep or sleeping too much.
Psychomotor agitation (noticeably fidgety and jittery) or psychomotor retardation (talking and moving slowly).
Significant weight gain/loss or significant increase/decrease in appetite.
Fatigue or loss of energy.

Emotional characteristics of depression

Sustained and extreme sadness.
Feelings of worthlessness.
Experience of extreme guilt.

Cognitive characteristics of depression

Difficulty concentrating and indecisiveness.
Suicidal ideation: thoughts of death (not just fear of dying), thinking about or planning suicide, or making an actual suicide attempt.
Poor self-esteem.

DSM diagnosis

According to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders, a person must show five or more of the symptoms just described for most days in a two week period or more to be diagnosed with depression.

Neurological and physiological evidence

Depression is linked to abnormal activity in several regions of the brain, including those important in assessing the emotional significance of stimuli and experiencing emotions (amygdala), and in regulating and controlling emotions (prefrontal cortex).
Researchers have also found that depressed individuals have abnormally high levels of the stress hormone cortisol. High levels of cortisol is a risk factor for future depression.
It is likely that high cortisol levels have a causal effect on depression.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a disorder that consists of obsessions and compulsions.

OCD

People with obsessive-compulsive disorder (OCD) experience thoughts and urges that are intrusive and unwanted (obsessions) and/or the need to engage in repetitive behaviours or mental acts (compulsions).
Sufferers of OCD often have obsessions and compulsions that are linked.
- For example, a person with this disorder might have an extreme fear of catching an illness (obsession) and so spend hours each day washing their hands (compulsion).

Cognitive characteristics of OCD

Obsessions are the cognitive aspect of OCD.
Obsessions are more than just unwanted thoughts that jump into our head. They are characterised as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing.
Common obsessions include concerns about germs and contamination, doubts, order and symmetry, and urges.
Usually, the person knows that such thoughts and urges are irrational and tries to suppress or ignore them, but has an extremely difficult time doing so.

Behavioural characteristics of OCD

Compulsions are the behavioural aspect of OCD.
Compulsions are repetitive and ritualistic acts that are typically carried out to minimise the distress that obsessions trigger or to reduce the likelihood of a feared event.
Compulsions often include behaviours such as repeated and extensive hand washing, cleaning, checking, and ordering. They also include mental acts such as counting, praying, or reciting something.
Compulsions characteristic of OCD are not done out of pleasure. They are not connected in a realistic way to the source of the distress or feared event.

Emotional characteristics of OCD

OCD can cause sufferers to experience severe anxiety and distress related to the obsessions.
In addition, people may feel guilt after an episode of a particularly distressing obsession.