Introduction: Understanding Abnormal Psychology
Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought that may be understood as mental disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, updated in 2022) provides the standard classification system used by mental health professionals to diagnose and treat psychological disorders. This cheat sheet offers a comprehensive overview of the major diagnostic categories, their key features, and relevant clinical considerations.
Core Concepts in Abnormal Psychology
The 4 Ds of Abnormal Psychology
- Deviance: Behavior differs significantly from societal norms
- Distress: Causes emotional suffering to the individual
- Dysfunction: Interferes with daily functioning and adaptive abilities
- Danger: Poses risk to self or others
Diagnostic Models
| Model | Key Focus | Example Approach |
|---|
| Biomedical | Biological/neurological factors | Medication, genetic testing |
| Psychological | Mental processes and behavior | Psychotherapy, behavioral interventions |
| Sociocultural | Social and cultural influences | Community support, cultural considerations |
| Biopsychosocial | Integration of multiple factors | Comprehensive treatment plans |
Clinical Assessment Methods
- Clinical interviews: Structured or unstructured conversations
- Psychological testing: Standardized measurement tools
- Behavioral observation: Direct observation of behavior
- Collateral information: Data from family members, medical records
DSM-5-TR Major Diagnostic Categories
Neurodevelopmental Disorders
Conditions that typically manifest early in development.
| Disorder | Key Features | Prevalence |
|---|
| Autism Spectrum Disorder | Social communication deficits, restricted/repetitive behaviors | 1-2% |
| Attention-Deficit/Hyperactivity Disorder | Inattention, hyperactivity, impulsivity | 5-7% in children, 2.5% in adults |
| Specific Learning Disorder | Difficulties with reading, writing, or mathematics | 5-15% |
| Intellectual Disability | Deficits in intellectual and adaptive functioning | ~1% |
Schizophrenia Spectrum and Other Psychotic Disorders
Characterized by disturbances in thinking, perception, and behavior.
| Disorder | Key Features | Average Age of Onset |
|---|
| Schizophrenia | Hallucinations, delusions, disorganized thinking, negative symptoms | Late teens to early 30s |
| Schizoaffective Disorder | Combined features of schizophrenia and mood disorder | Early to late 20s |
| Delusional Disorder | Non-bizarre delusions without other psychotic symptoms | Middle to late adulthood |
| Brief Psychotic Disorder | Psychotic symptoms lasting 1 day to 1 month | Variable |
Bipolar and Related Disorders
Characterized by extreme shifts in mood and energy levels.
| Disorder | Key Features | Episode Types |
|---|
| Bipolar I | Manic episodes (may include psychotic features), may have depressive episodes | Mania, hypomania, depression |
| Bipolar II | Hypomanic and depressive episodes (no full mania) | Hypomania, depression |
| Cyclothymic Disorder | Chronic fluctuating hypomanic and depressive symptoms | Subsyndromal hypomania and depression |
Depressive Disorders
Characterized by persistent sad mood and loss of interest or pleasure.
| Disorder | Key Features | Duration Criteria |
|---|
| Major Depressive Disorder | Depressed mood, anhedonia, changes in sleep/appetite/energy | At least 2 weeks |
| Persistent Depressive Disorder | Chronic depressed mood | At least 2 years |
| Premenstrual Dysphoric Disorder | Mood symptoms tied to menstrual cycle | During premenstrual phase |
Anxiety Disorders
Characterized by excessive fear, anxiety, and related behavioral disturbances.
| Disorder | Key Features | Common Manifestations |
|---|
| Generalized Anxiety Disorder | Persistent, excessive worry about multiple domains | Restlessness, fatigue, difficulty concentrating |
| Panic Disorder | Recurrent unexpected panic attacks with concern about future attacks | Heart palpitations, shortness of breath, fear of losing control |
| Social Anxiety Disorder | Fear of social situations and negative evaluation | Avoidance of social situations, physical symptoms in social contexts |
| Specific Phobia | Intense fear of specific objects or situations | Immediate anxiety response, avoidance |
Obsessive-Compulsive and Related Disorders
Characterized by obsessions (intrusive thoughts) and/or compulsions (repetitive behaviors).
| Disorder | Key Features | Common Presentations |
|---|
| OCD | Obsessions and compulsions causing distress/impairment | Contamination fears, checking, symmetry/order needs |
| Body Dysmorphic Disorder | Preoccupation with perceived defects in appearance | Mirror checking, skin picking, seeking reassurance |
| Hoarding Disorder | Difficulty discarding possessions | Cluttered living spaces, distress about discarding |
| Trichotillomania | Recurrent hair pulling | Noticeable hair loss, tension before pulling |
Trauma and Stressor-Related Disorders
Disorders related to exposure to traumatic or stressful events.
| Disorder | Key Features | Symptom Clusters |
|---|
| Post-Traumatic Stress Disorder | Symptoms following trauma exposure | Intrusion, avoidance, negative alterations in cognition/mood, arousal |
| Acute Stress Disorder | Similar to PTSD but within first month of trauma | Similar to PTSD but shorter duration |
| Adjustment Disorders | Emotional/behavioral symptoms in response to stressor | Varies based on subtype (with anxiety, depression, etc.) |
Dissociative Disorders
Characterized by disruption in normally integrated functions of consciousness, memory, identity, or perception.
| Disorder | Key Features |
|---|
| Dissociative Identity Disorder | Two or more distinct personality states |
| Dissociative Amnesia | Inability to recall important autobiographical information |
| Depersonalization/Derealization Disorder | Feeling detached from self or surroundings |
Somatic Symptom and Related Disorders
Focus on physical symptoms and health concerns.
| Disorder | Key Features |
|---|
| Somatic Symptom Disorder | Distressing somatic symptoms with excessive thoughts/feelings |
| Illness Anxiety Disorder | Preoccupation with having or acquiring serious illness |
| Conversion Disorder | Neurological symptoms not explained by medical condition |
Feeding and Eating Disorders
Characterized by disturbed eating behaviors and related thoughts and emotions.
| Disorder | Key Features | Medical Complications |
|---|
| Anorexia Nervosa | Restriction of food intake, fear of weight gain, distorted body image | Cardiac issues, osteoporosis, electrolyte imbalances |
| Bulimia Nervosa | Binge eating with compensatory behaviors | Dental erosion, electrolyte imbalances, GI problems |
| Binge Eating Disorder | Recurrent episodes of binge eating without compensatory behaviors | Obesity-related complications |
| Avoidant/Restrictive Food Intake Disorder | Limited food intake not due to body image concerns | Nutritional deficiencies, weight loss |
Sleep-Wake Disorders
Disturbances in sleep quality, timing, or duration.
| Disorder | Key Features |
|---|
| Insomnia Disorder | Difficulty initiating/maintaining sleep |
| Hypersomnolence Disorder | Excessive daytime sleepiness |
| Narcolepsy | Excessive daytime sleepiness with cataplexy |
| Breathing-Related Sleep Disorders | Sleep disruption due to breathing issues (e.g., sleep apnea) |
| Circadian Rhythm Sleep Disorders | Misalignment between desired/required and actual sleep patterns |
| Parasomnias | Abnormal behaviors during sleep (sleepwalking, night terrors, etc.) |
Substance-Related and Addictive Disorders
Problems related to use of substances or addictive behaviors.
| Category | Examples | Key Diagnostic Features |
|---|
| Substance Use Disorders | Alcohol, cannabis, opioid, stimulant use disorders | Impaired control, social impairment, risky use, pharmacological criteria |
| Substance-Induced Disorders | Substance-induced psychosis, anxiety, depression | Direct physiological effects of substance |
| Behavioral Addictions | Gambling disorder | Addiction-like behaviors without substance use |
Neurocognitive Disorders
Characterized by primary clinical deficits in cognitive function.
| Disorder | Key Features | Common Etiologies |
|---|
| Delirium | Disturbance in attention and awareness, develops over short period | Medication side effects, infection, metabolic disturbances |
| Major Neurocognitive Disorder | Significant cognitive decline interfering with independence | Alzheimer’s disease, vascular disease, Lewy body disease |
| Mild Neurocognitive Disorder | Modest cognitive decline without interference with independence | Same as major, but earlier stage |
Personality Disorders
Enduring patterns of inner experience and behavior that deviate from cultural expectations.
| Cluster | Disorders | Core Features |
|---|
| A (Odd/Eccentric) | Paranoid, Schizoid, Schizotypal | Social detachment, suspiciousness, eccentricity |
| B (Dramatic/Emotional) | Antisocial, Borderline, Histrionic, Narcissistic | Emotional instability, impulsivity, attention-seeking, grandiosity |
| C (Anxious/Fearful) | Avoidant, Dependent, Obsessive-Compulsive | Anxiety, fear, excessive need for control or care |
Clinical Assessment Process
1. Initial Screening and Referral
- Brief assessment tools
- Determination of need for specialized assessment
2. Comprehensive Assessment
- Clinical interview: Chief complaint, history, mental status examination
- Standardized testing: Symptom inventories, personality assessments, cognitive testing
- Functional assessment: Impact on daily living activities
- Risk assessment: Suicide, homicide, self-harm
3. Formulation and Diagnosis
- Integration of assessment data
- Application of DSM-5-TR criteria
- Differential diagnosis considerations
- Cultural formulation
4. Treatment Planning
- Biopsychosocial approach
- Evidence-based intervention selection
- Severity and chronicity considerations
- Client preferences and resources
Common Challenges in Diagnosis and Solutions
| Challenge | Solution |
|---|
| Comorbidity | Prioritize treatment targets, use dimensional assessment |
| Cultural variations | Apply cultural formulation interview, consider cultural concepts of distress |
| Symptom overlap | Focus on distinguishing features, track symptom patterns over time |
| Developmental considerations | Adapt assessment to developmental level, consider age-specific manifestations |
| Malingering vs. genuine symptoms | Use validity measures, collateral information, observation over time |
Best Practices in Abnormal Psychology
Ethical Considerations
- Maintain confidentiality with appropriate limits
- Obtain informed consent for assessment and treatment
- Use least restrictive interventions
- Respect client autonomy and dignity
- Practice within scope of competence
Evidence-Based Assessment
- Use measures with strong psychometric properties
- Employ multiple methods and informants when possible
- Regularly reassess symptoms and functioning
- Consider both categorical and dimensional approaches
Therapeutic Alliance
- Develop collaborative relationship
- Use empathic, non-judgmental approach
- Involve client in treatment planning
- Address stigma and misconceptions
Cultural Competence
- Recognize cultural influences on symptom expression
- Adjust diagnostic thresholds based on cultural norms
- Consider cultural strengths and resources
- Use culturally adapted assessment measures
Resources for Further Learning
Professional Organizations
- American Psychiatric Association (APA)
- American Psychological Association (APA)
- National Institute of Mental Health (NIMH)
- World Health Organization (WHO)
Key Texts and Manuals
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
- International Classification of Diseases (ICD-11)
- Abnormal Psychology textbooks (e.g., Barlow & Durand; Nolen-Hoeksema)
- Clinical handbooks for specific disorders
Training Resources
- Online continuing education courses
- Clinical workshops and supervision
- Case formulation guides
- Assessment instrument manuals
Research Databases
- PsycINFO
- PubMed
- Cochrane Database of Systematic Reviews
Clinical Specifiers and Modifiers in DSM-5-TR
Severity Specifiers
Course Specifiers
- Single episode
- Recurrent
- Persistent
- In partial remission
- In full remission
Special Population Considerations
- Children/Adolescents: Developmental manifestations often differ
- Older Adults: May present with atypical symptoms
- Pregnant/Postpartum Women: Higher risk for mood disorders
- Individuals with Intellectual Disability: May show behavioral equivalents
Practice Implications
- Documentation requires specific codes and specifiers
- Treatment selection often depends on severity and specifiers
- Prognosis may vary based on specifiers
- Insurance coverage may be linked to specific diagnostic codes
