Disorder

Major depressive disorder (MDD)

Symptoms

• Sad mood OR loss of pleasure in usual activities

AND at least five symptoms:

• Sleeping too much or too little

• Psychomotor retardation or agitation

• Weight loss or change in appetite

• Loss of energy

• Feelings of worthlessness or excessive guilt

• Recurrent thoughts about death or suicide

• Difficulty concentrating, thinking or making decisions

Time

2 weeks

Prevalence

16%

Comorbidity

High

Other

• More women than men

• Episodic

• Socio-economic status important factor in prevalence

Disorder

Persistent depressive disorder (dysthymia)

Symptoms

• Depressed mood for most of the day more than half of the time for 2 years

AND at least two five symptoms during that time:

• Poor appetite or overeating

• Sleeping too much or too little

• Low energy

• Poor self-esteem

• Trouble concentrating or making decisions

• Feelings of hopelessness

Time

2 years. Symptoms do not clear for more than 2 months at a time.

Prevalence

2.5%

Comorbidity

High

Other

• More women than men

• No presence of a bipolar disorder

• Socio-economic status important factor in prevalence

Disorder

Season affective disorder

Symptoms

• Depressive episode (see above) during two consecutive winters

Time

At least two consecutive winters

Prevalence

Not specific

Comorbidity

High

Other

• No symptoms in other seasons than winter

• More women than men

Disorder

Bipolar I disorder

Symptoms

• A single episode of mania during the course of a person’s life

• Mania not explained by another disorder, substance abuse or medical condition.

Time

One manic episode during the course of a person’s life. Manic episodes last approximately one week.

Prevalence

0.6%

Comorbidity

High

Other

• Manic episodes tend to recur

Disorder

Bipolar II disorder

Symptoms

• One major depressive episode and one episode of hypomania

• No lifetime episode of mania

Time

One hypomanic and one major depressive episode during the course of a person’s life.

Prevalence

0.4% - 2%

Comorbidity

High

Disorder

Cyclothymic disorder

Symptoms

• Numerous period with hypomanic symptoms that do not meet criteria for a hypomanic episode

• Numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

Time

Symptoms do not clear for more than two months at a time.

Prevalence

4%

Comorbidity

High

Other

• Symptoms need to cause significant distress OR functional impairment

Disorder

Manic episode

Symptoms

• Distinctly elevated OR irritable mood

• Abnormally increased activity OR energy

AND at least three differences from baseline (four if irritable mood)

• Increase in goal directed activity or psychomotor agitation

• Unusual talkativeness; rapid speech

• Flight of ideas or subjective impression that thoughts are racing

• Decreased need for sleep

• Increased self-esteem

• Distractibility

• Excessive involvement in activities that are likely to have painful consequences (e.g: reckless spending or sexual indiscretions)

• Symptoms are present most of the day, nearly every day

Time

Symptoms are present most of the day, nearly every day. Symptoms last one week.

Prevalence

Comorbidity

Other

• Symptoms require hospitalization OR include psychosis

• Symptoms cause significant distress OR functional impairment

Disorder

Hypomanic episode

Symptoms

• Distinctly elevated OR irritable mood

• Abnormally increased activity OR energy

AND at least three differences from baseline (four if irritable mood)

• Increase in goal directed activity or psychomotor agitation

• Unusual talkativeness; rapid speech

• Flight of ideas or subjective impression that thoughts are racing

• Decreased need for sleep

• Increased self-esteem

• Distractibility

• Excessive involvement in activities that are likely to have painful consequences (e.g: reckless spending or sexual indiscretions)

• Symptoms are present most of the day, nearly every day

Time

Symptoms are present most of the day, nearly every day. Symptoms last at least four days.

Prevalence

Comorbidity

Other

• Clear changes in functioning are observable to others, but impairment is not marked.

• No psychotic symptoms are present

Disorder

Specific phobia

Symptoms

• Marked and disproportionate fear consistently triggered by specific objects or situations

• The object or situation is avoided or else endured with intense anxiety

Time

Not specified

Prevalence

13.8%

Comorbidity

High (substance abuse, depression and personality disorders)

Other

• The object of phobia may elicit intense disgust

• More women than men

• Culture can determine object of phobia

Disorder

Social anxiety disorder

Symptoms

• Marked and disproportionate fear consistently triggered by exposure to potential social examination

• Exposure to trigger leads to intense anxiety about being evaluated negatively

• Trigger situations are avoided or else endured with intense anxiety

Time

Not specified

Prevalence

13%

Comorbidity

High (substance abuse, depression and personality disorders)

Other

• People with social anxiety disorder can demonstrate aggressive and hostile behaviour in the face of potential social rejection

• Social anxiety can be about a specific social situation (e.g: speaking in public)

• More women than men

Disorder

Panic disorder

Symptoms

• Recurrent unexpected panic attacks

• At least one month of concern or worry about the possibility of more attacks occurring or the consequences of an attack OR maladaptive behavioural changes because of the attack

Time

Worry or change behaviour for at least one month

Prevalence

5.2%

Comorbidity

High (substance abuse, depression and personality disorders)

Other

• Panic attacks are unrelated to specific situations

• Onset typically in adolescence

• More women than men

Disorder

Agoraphobia

Symptoms

• Disproportionate and marked fear about at least two situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing symptoms or panic-like symptoms.

• The situations consistently provoke fear or anxiety

• The situations are avoided AND/OR require the presence of a companion or are endured with intense fear or anxiety

Time

At least six months

Prevalence

2.6%

Comorbidity

High (substance abuse, depression and personality disorders)

Other

• Does not require panic attacks

• Significant impairment in daily functioning

• More women than men

Disorder

Generalized anxiety disorder (GAD)

Symptoms

• Excessive anxiety and worry at least 50% of days about a number of events or activities

• The person finds it hard to control the worry

AND at least three symptoms:

• Restlessness or feeling keyed up or on edge

• Easily fatigued

• Difficulty concentrating or mind going blank

• Irritability

• Muscle tension

• Sleep disturbance

Time

At least six months

Prevalence

6.2%

Comorbidity

High (substance abuse, depression and personality disorders)

Other

• Culture may influence the focus of fears

• More women than men

Disorder

Panic attack

Symptoms

• Intense apprehension, terror and feelings of impending doom

AND at least four symptoms:

• Shortness of breath

• Heart palpitations

• Nausea

• Upset stomach

• Chest pain

• Feelings of choking and smothering

• Dizziness

• Light-headedness

• Faintness

• Sweating

• Chills

• Heat sensations

• Numbness or tingling sensations

• Trembling

Time

Peak intensity after ten minutes

Prevalence

Comorbidity

Other

• Depersonalization and derealization can occur during a panic attack

Disorder

Obsessive-compulsive disorder (OCD)

Symptoms

• Obsessions AND/OR compulsions

Obsessions include:

• Recurrent, intrusive, persistent, unwanted thoughts, urges or images

• The person tries to ignore, suppress or neutralize the thoughts, urges or images

Compulsions include:

• Repetitive behaviour o thoughts that the person feels compelled to perform to prevent distress or a dreaded event

• The person feels driven to perform the repetitive behaviours or thoughts in response to obsessions or according to rigid rules

• The acts are excessive or unlikely to prevent the dreaded situation

Time

At least one hour per day

Prevalence

2%

Comorbidity

High (depression and anxiety disorders)

Other

• Typically begins before age 10 or in late adolescence / early adulthood

Disorder

Body dysmorphic disorder

Symptoms

• Preoccupation with one or more perceived defects in appearance

• Others find the perceived defect(s) slight or unobservable

• The person has performed repetitive behaviours or mental acts in response to the appearance concerns

• Preoccupation is not restricted to concerns about weight or body fat

Time

Not specified

Prevalence

2%

Comorbidity

High (depression and anxiety disorders)

Other

• Associated with suicide ideation

Disorder

Hoarding disorder

Symptoms

• Persistent difficulty discarding or parting with possessions regardless of their actual value

• Perceived need to save items

• Distress associated with discarding

• The symptoms result in the accumulation of a large number of possessions that clutter active living spaces to the extent that their intended use is compromised unless others intervene

Time

Not specified

Prevalence

1.5%

Comorbidity

High (depression and anxiety disorders)

Other

• People with hoarding disorder are often unaware of the severity of their behaviour

• Hoarding behaviour typically starts in childhood or early adolescence

• Animal hoarding typically does not emerge until middle age or older

Disorder

Posttraumatic stress disorder (PTSD)

Symptoms

• Having experienced a trauma

At LEAST one: (intrusion)

• Recurrent, involuntary and intrusive distressing memories of the trauma

• Recurrent distressing dreams related to the event(s)

• Dissociative reactions in which the individual feels or acts as if the trauma were recurring

• Intense or prolonged distress or physiological reactivity in response to reminders of the trauma

At LEAST one: (avoidance)

• Avoidance of internal reminders of the trauma(s)

• Avoidance of external reminders of the trauma(s)

At LEAST two: (negative alterations in cognition and mood)

• Inability to remember an important aspect of the trauma

• Persistent and exaggerated negative beliefs or expectations about one’s self, others or the world

• Markedly diminished interest or participation in significant activities

• Feeling of detachment or estrangement from others

• Persistent ability to experience positive emotions

At LEAST two: (arousal and activity)

• Irritable or aggressive behaviour

• Reckless or self-destructive behaviour

• Hypervigilance

• Exaggerated startle response

• Problems with concentration

• Sleep disturbance

Time

Symptoms begin or worsened after the trauma and continued for at least one month.

Prevalence

Different for all traumas. The more severe the trauma, the greater the probability of PTSD.

Comorbidity

High (depression and anxiety disorders)

Other

• Women are twice as likely to develop PTSD than men.

• Human related traumas are more likely to lead to PTSD.

Disorder

Acute stress syndrome

Symptoms

• Symptoms similar to the symptoms of posttraumatic stress disorder (see above)

Time

Symptoms last three days to one month

Prevalence

Not specified

Comorbidity

Not specified

Other

• Could potentially stigmatize normal short-term reactions to trauma

Disorder

Depersonalization/derealization disorder

Symptoms

• Depersonalization

• Derealization

• Symptoms are persistent OR recurrent

• Reality testing remains intact

• Symptoms are not explained by substanes, another dissociative disorder, another psychological disorder, or by a medical condition.

Time

Not specified

Prevalence

0.8% - 1.9%

Comorbidity

High (depression, anxiety and personality disorders

Other

• No disturbances of memory

• Typically begins in adolescence

• Typically triggered by stress

Disorder

Dissociative amnesia

Symptoms

• Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness

• The amnesia is not explained by substances or by other medical psychological conditions

Time

Begins suddenly. Disappears suddenly.

Prevalence

Differs across countries and populations

Comorbidity

Not specified

Other

• Typically a full recovery

• Procedural memory remains intact in periods of amnesia

Disorder

Dissociative fugue

Symptoms

• Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness

• The amnesia is not explained by substances or by other medical psychological conditions

• Bewildered OR apparently purposeful wandering

Time

Begins suddenly. Disappears suddenly.

Prevalence

Differs across countries and populations

Comorbidity

Not specified

Other

• Typically a full recovery

• Procedural memory remains intact in periods of amnesia

• Social contacts during purposeful wandering are minimal or absent

Disorder

Dissociative identity disorder

Symptoms

• Disruption of identity characterized by two or more personality states or an experience of possession. These disruptions lead to discontinuities in the sense of self or agency, as reflected in altered cognition, behaviour, affect, perceptions, consciousness, memories or sensory-motor functioning. The disruptions may be observed by others or the patient

• Recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting

• Symptoms are not part of a broadly accepted cultural or religious practice

• Symptoms are not due to drugs or a medical condition

Time

Not specified

Prevalence

1%

Comorbidity

High (depression, somatic symptom-, personality- and posttraumatic stress disorder)

Other

• Much more common in women than in men

• Early childhood trauma plays an important role in the disorder

• Often accompanied by headaches, hallucinations, suicide attempts and self-injurious behaviour

• The disorder is possibly iatrogenic

Disorder

Somatic symptom disorder

Symptoms

• At least one somatic symptom that is distressing or disrupts daily life

Excessive thought, distress and behaviour related to somatic symptom(s) or health concerns, as indicated by at LEAST one of the following:

• Health-related anxiety

• Disproportionate and persistent concerns about the seriousness of symptoms

• Excessive time and energy devoted to health concerns

Time

At least six months

Prevalence

5% - 7%

Comorbidity

High (anxiety-, mood-, substance use- and personality disorders)

Other

• Disorder can be diagnosed regardless of whether symptoms can be explained medically

• More women than men

Disorder

Illness anxiety disorder

Symptoms

• Preoccupation with and high level of anxiety about having OR acquiring a serious disease

• Excessive illness behaviour or maladaptive avoidance

• No more than mild somatic symptoms are present

• Not explained by other psychological disorders

Time

At least six months

Prevalence

1.3% - 10%

Comorbidity

High (anxiety- and mood disorders)

Other

• Does not require somatic symptoms to be present

• Medical evaluations are often not trusted

Disorder

Conversion disorder

Symptoms

• One or more symptoms affecting voluntary motor or sensory function

• The symptom(s) are incompatible with recognized medical disorder

• Symptom(s) cause significant distress or functional impairment or warrant medical evaluation

Time

Not specified

Prevalence

Less than 1%

Comorbidity

High (somatic-, dissociative-, substance use- and personality disorders)

Other

• More women than men

• Typically develops in adolescence or early adulthood

• Typically develops after a major life stressor

• More common in rural areas and with people from lower socioeconomic status

• Modelling and social factors shape how conversion symptoms unfold

Disorder

Factitious disorder

Symptoms

• Fabrication or induction of physical or psychological symptoms, injury or disease

• Deceptive behaviour is present in the absence of obvious external rewards

Factitious disorder on SELF if:

• The person presents him- or herself to others as ill, impaired or injured

Factitious disorder on OTHERS if:

• The person fabricates or induces symptoms in another person and then presents that person to others as ill, impaired or injured

Time

Not specified

Prevalence

0.6% - 3%

Comorbidity

Not specified

Other

• There is no malingering

• Goal is to adopt the patient role

Type of treatment

Treatment

How it works

Psychological

Interpersonal therapy

Examine interpersonal problems and identify feelings about these problems

Psychological

Cognitive therapy

Change cognitions. Computer-based cognitive therapy is effective.

Psychological

Mindfulness-based cognitive therapy (MBCT)

Adopt a decentred perspective to prevent escalation of negative thoughts. It helps prevent relapse.

Psychological

Behavioural activation (BA) therapy

Increase participation in positively reinforcing activities to disrupt the spiral of depression.

Psychological

Behavioural couples therapy

Improve communication and relationship satisfaction.

Psychological

Psychoeducation

Learn people more about the depression and how to manage symptoms. NOTE: does not treat mood disorders, but can be helpful.

Biological

Electroconvulsive therapy (ECT)

Deliberately inducing a momentary seizure in a person’s brain. Used for depression that does not respond to medication, but can lead up to cognitive deficits up till six months later.

Biological

Medication

Medication such as SSRI. Only really effective in severe depression. Medication after depression reduces probability of relapse. Bipolar disorder requires lithium, antipsychotic or anti-seizure medication.

Biological

Transcranial magnetic stimulation (TMS)

Magnetic pulses are used to increase activity in dorsolateral prefrontal cortex. Only for people who don’t respond to first medication.

Disorder

Type of treatment

Treatment

How it works

Phobias

Psychological

Exposure

Exposure to the fear object reduces fear. Gradual exposure works best.

Social anxiety disorder

Psychological

Exposure

Exposure to the fear object, social skills training. Teach people to stop using safety behaviour and change attention from the self to external stimuli.

Panic disorder

Psychological

Panic control therapy (PCT)

Elicit bodily sensations and learn coping techniques for these sensations.

Agoraphobia

Psychological

Cognitive behavioural treatment (CBT)

Exposure to the fear object.

Generalized anxiety disorder (GAD)

Psychological

Cognitive behavioural treatment (CBT)

Challenge people to worry only one specific time of the day. Includes relaxation training and help people tolerate uncertainty.

All

Biological

Medication

Benzodiazepines, anti-depressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to reduce anxiety.

Disorder

Type of treatment

Treatment

How it works

OCD

Psychological

Exposure and prevention (ERP)

Exposure to the fear object and not performing the ritual to reduce anxiety to let anxiety gradually decline.

BDD

Psychological

Exposure and prevention (ERP)

Exposure to the feared activities and avoiding rituals that reassure people about their appearance.

Hoarding disorder

Psychological

Exposure and prevention

Exposure to feared activities and avoiding anxiety reducing rituals. NOTE: motivational strategies are necessary as insight is necessary to address symptoms

OCD

Biological

Deep brain stimulation

Implanting electrodes in the brain. Only used for severe cases that do not respond to other therapies.

All

Biological

Medication

Antidepressants help fight symptoms of obsessive-compulsive and related disorders.

Disorder

Type of treatment

Treatment

How it works

Acute stress disorder

Psychological

Exposure treatment

Exposure to the trauma-related activities or objects.

Posttraumatic stress disorder (PTSD)

Psychological

Exposure treatment

Exposure to the trauma-related activities or objects.

Posttraumatic stress disorder

Psychological

Early exposure treatment

Early exposure to the trauma-related activities of objects.

Posttraumatic stress disorder

Psychological

Eye movement desensitization and reprocessing (EMDR)

Bilateral stimulation through stimulation eye movements while working through the trauma.

All

Biological

Medication

Antidepressants help fight symptoms of posttraumatic stress disorder.

Disorder

Type of treatment

Treatment

How it works

All

Psychological

Cognitive therapy

Change cognitions about relevant stimuli.

Dissociative identity disorder

Psychological

Cognitive therapy

Convince people that splitting into multiple personalities is no longer necessary to deal with stress.

Dissociative identity disorder

Psychological

Stress-coping techniques

Learn people stress-coping techniques to deal with trauma.

Dissociative identity disorder

Psychological

Age regression

Using hypnosis and encouraging people to go back in the mind to traumatic events in childhood. NOTE: this could worsen symptoms

Dissociative identity disorder

Psychological

Exposure treatment

Exposure to the trauma. NOTE: it is not always clear what the trauma is.

All

Biological

Medication

Medication for the potential other disorders, as the disorders are highly comorbid.

Disorder

Type of treatment

Treatment

How it works

Somatic symptom disorder

Psychological

Acceptance and commitment therapy

Learn a more accepting attitude towards pain, suffering and moments of depression.

All

Psychological

Interventions in primary care

Teach primary care workers to tailor care for people with these disorders. Includes informing workers when someone is a frequent user of health care services.

All

Psychological

Cognitive behavioural treatment

Learn people to pay less attention to their bodies. Focus on what people can still do and not on what they cannot do.

All

Biological

Medication

Antidepressants can reduce symptoms if pain is the dominant symptom.