Identifying Psychological Problems
The most reliable and objective way of determining the nature and cause of symptoms is through a complete diagnostic assessment. The first visit should be to the family doctor. There are many medical conditions that can give rise to depression, anxiety-like or other psychological symptoms and it is important to rule-out medical or biological causes before exploring a psychological explanation. Some medical conditions require urgent specialist treatment.
When underlying medical problems have been ruled-out possible psychological problems can be explored. One way to do this is to ask your doctor to make a referral to a clinical psychologist or psychiatrist for an assessment. The initial assessment interview will take 1-2 hours and the psychologist or psychiatrist will take a detailed description of symptoms and their history. You will probably be given some short questionnaires to complete to assess the severity of your symptoms and the extent of any mood disturbance. On the basis of assessment a course of action might be recommended, this may involve further assessment or treatment of some kind. You can influence the course of action taken and you should make any preferences known.
Listed below is a brief description of (not all) psychological disorders. It is important to note that many of the symptoms described are common, and having them does not automatically mean they are a sign of psychological disorder. They become a disorder only when they significantly impair the person’s functioning and cause considerable distress.
Psychological problems fall into the below categories.
Panic Disorder: This is marked by sudden increases in anxiety that occur rapidly within 10 minutes. At some point in the disorder the panic attacks occurred unexpectedly and out of the blue. In this disorder the person often fears that they are about to collapse, die or lose control when panicking. Avoidance of situations can develop as a means of avoiding panic; this can be a sign of agoraphobia.
Social Anxiety Disorder: This is marked by a fear of social situations in which the person may act in a way that is embarrassing. This includes fear of showing anxiety or symptoms such as sweating, blushing or not being able to speak. These situations are either avoided or endured under considerable distress.
Obsessive-compulsive disorder: This problem is marked by unwanted thoughts or impulses that are experienced as disgusting or out of character. Often these involve violent, sexual or blasphemous themes. In some types they concern fears of contamination by germs, dirt or bodily fluids. The problem is associated with performing rituals such as washing, checking, counting or repeating actions to reduce discomfort. Many people have obsessional thoughts and perform rituals but this is not a disorder unless they are time consuming, interfere with normal functioning or cause considerable distress.
Generalised Anxiety Disorder: This problem is identified by the repeated occurrence of difficult to control worry about different topics and a range of physical symptoms such as muscle tension, agitation, and sleep disturbance. The difference between normal worry (which most people have) and worry in GAD is that in GAD it is difficult to control and excessive.
Post-traumatic stress (PTSD): This problem occurs after exposure to a threatening trauma. It consists of characteristic symptoms of re-experiencing in the form of intrusive thoughts or memories of the event; arousal in the form of anxiety symptoms and exaggerated startle responses; and avoidance such as avoiding reminders of the trauma or the place it occurred. These symptoms are common and can be normal but in most instances subside within a month of exposure to the traumatic event. If they last longer than this then this may be an indication of PTSD.
Hypochondriasis: Despite medical reassurance a person is preoccupied with the fear of having or believes that they have a life-threatening disease. This problem belongs in the category of somatoform disorders but is similar in many respects to anxiety disorders.
There are different types of eating disorder which include anorexia, bulimia and related conditions. In anorexia there is restriction in food or calorie intake associated with a fear of gaining weight. There may be significant disturbance in body-image.
In bulimia there is binging in which the person eats more than they intended to and this is often followed by purging that involves vomiting or laxative use. Eating disorder behaviours can be harmful and medical advice should be sought.
There are different types of depression. They are all associated with mood disturbances in which the person feels sad or loses interest in activities. There is often sleep and appetite disturbance. There may be single or repeated episodes of depression that can last a couple of weeks to several months or years. The most common depressive disorder is called major depressive disorder. Some people suffer from mood swings that move from elation and impulsivity to depression, in these circumstances the problem may be bipolar disorder.
These disorders consist of symptoms such as hallucinations, delusional beliefs, and disordered speech such as incoherence. Hallucinations may be normal for some cultures and religious practices in which case they would not be counted. There are different subtypes of schizophrenia in the category of psychotic disorder.
There are 10 specific personality disorders. These disorders are marked by an enduring pattern of subjective experience and behaviour that are inflexible and cause significant impairment in functioning or distress. These difficulties are stable and of long duration and can be traced back to adolescence or early childhood. For a diagnosis of these problems the clinician must be able to differentiate the effects of more transient anxiety and mood disorders from the effects of personality.
Other Disorder Categories
The list of disorder types described here is not exhaustive. There are other categories not described here that include other somatoform disorders such as body-dysmorphic disorder which is preoccupation with an imagined or exaggerated defect in appearance. There are also sleep disorders, sexual and gender identity disorders, dissociative disorders, and substance-related disorders.