Clinical characteristics of mental health issues
Specification: The behavioural, emotional and cognitive characteristics of phobias, depression and obsessive compulsive disorder (OCD).
Phobias
Phobias are classed as anxiety disorders. Anxiety is a natural response to a perceived threat, but a phobia is an irrational, persistent and extreme fear of something. It compels you to avoid it, despite reassurance that it is harmless. It goes beyond normal fear of real danger. You need to know how people feel, think and behave when they have this disorder.
In the UK, psychiatrists use the ICD (International Statistical Classification of Diseases and Related Health Problems) diagnostic system to diagnose psychological disorders. Three psychological disorders include: phobias, depression and obsessive compulsive disorder (OCD).
The ICD outlines possible symptoms in relation to phobias, depression and OCD and these symptoms can be categorised as behavioural, emotional and cognitive.
DSM-5 categorisation of phobias
All phobias are characterised by an extreme and irrational response to a stimulus. The DSM-5 recognises three categories:
1. Specific phobia – phobia of an object such as an animal or insect
2. Social phobia – social anxiety, such as public speaking
3. Agoraphobia – fear of being outside in public places
Specific phobias
Simple, or specific, phobias are the most common type of phobia. This is where a person fears a specific object in the environment, for example arachnophobia, the fear of spiders. Simple phobias are further divided into four categories: animal phobias, injury phobias, situational phobias and natural phobias.
Common animal phobias include arachnophobia and ophidiophobia. Injury phobias include haematophobia, the fear of blood. Situational phobias include aerophobia, the fear of flying and natural phobias include hydrophobia, the fear of water.
Social phobias
Social phobias involve feelings of anxiety in social situations, for example, when giving a speech in public. Sufferers feel like they are being judged, which leads to feelings of inadequacy and apprehension. Social phobias are further divided into three categories: performance phobias, interaction phobias and generalised phobias.
Performance phobias result in feelings of anxiety when performing in public, for example, eating in a restaurant with friends; interaction phobias result in feelings of anxiety when mixing with others, for example, when answering questions during an interview and generalised phobias result in feelings of anxiety when other people are present, for example, when in a large crowd at a music concert.
Agoraphobia
Agoraphobia is a fear of open or public spaces and sufferers may experience panic attacks and anxiety, which make them feel vulnerable in open spaces.
Agoraphobia can be caused by simple phobias and/or social phobias. For example, the simple phobia mysophobia, which is the fear of contamination, could lead to a fear of public spaces.
Depression
Depression is a long-term mood or affective disorder that severely disrupts daily functioning. It comes in several forms, the most common types being unipolar and bipolar depression. (The DSM-5 does not use these categories but they are still in common use with clinicians.)
Depression is a category of mood disorders, which is often divided into two main types: unipolar and bipolar disorder (formerly known as manic‐depression).
To be given a diagnosis of depression, sufferers are required to display at least five symptoms, every day, for at least two weeks.
Behavioural Characteristics: There are numerous behavioural characteristics associated with depression, including: loss of energy, sleep disturbance and changes in appetite. Firstly, there is often a change in activity level; sufferers of depression often experience a reduction in energy and constantly feel tired. Furthermore, sufferers often experience disturbances with their sleeping pattern, with some sufferers sleeping significantly more, while others experience insomnia, which is an inability to sleep. Finally, sufferers often experience changes in appetite, which cause significant weight changes. Some sufferers will eat less and lose weight, while others will eat more and gain weight.
Emotional Characteristics: They key emotional characteristic of depression is a depressed mood, or feelings of sadness. Sufferers of depression will often experience the following: depressed mood, feelings of worthlessness and lack of interest or pleasure in all activities.
Although a depressed mood is the most common emotional characteristic of depression, some sufferers experience anger, which can be directed at themselves, or others. Anger can also lead to self‐harming behaviours.
Cognitive Characteristics: In addition to the emotional and behavioural characteristics, sufferers of depression often have a diminished ability to concentrate and a tendency to focus on the negative.
Sufferers of depression find it difficult to pay or maintain attention and are often slower in responding to, or making, decisions. Furthermore, they are inclined to focus on the negative aspects of a situation, while ignoring the positives and in some cases, experience recurrent thoughts of self‐harm, death or suicide.
OCD
Obsessive compulsive disorder (OCD) is an anxiety disorder characterised by obsessive thoughts and repetitive compulsive behaviours. OCD usually begins in teenage years or early adulthood and appears to run in families, suggesting a genetic link. It is equally common in males and females.
OCD (Obsessive Compulsive Disorder), like phobias, is classified as an anxiety disorder and has two main components, obsessions and compulsions. Obsessions are reoccurring and persistent thoughts and compulsions are repetitive behaviours. 70% of OCD sufferers experience combined obsessions and compulsions. However, 20% experience just obsessions and 10% experience just compulsions.
Behavioural Characteristics: The behavioural component of OCD centres on the compulsive behaviour, and for sufferers of OCD compulsions have two properties. Firstly, compulsions are repetitive in nature and sufferers will often feel compelled to repeat a behaviour such as repetitive hand washing. Secondly, compulsions are used to manage or reduce anxiety. For example, the excessive hand washing is caused by an excessive fear of germs and bacteria and is therefore a direct response to the obsession.
Emotional Characteristics: The emotional characteristics of OCD are mainly characterised by anxiety which is caused by the obsessions. However, some sufferers of OCD also experience depression. Obsessions are persistent and/or forbidden thoughts and ideas, which cause high levels of anxiety in OCD sufferers. Furthermore, OCD can often lead to depression, as the anxiety experienced can result in a low mood and loss of pleasure in everyday activities because these everyday tasks are being interrupted by obsessive thoughts and repetitive compulsions.
Cognitive Characteristics: Obsessive thoughts are the main cognitive feature of OCD. Examples of recurring thoughts include: fear of contamination, by dirt or germs; fear of safety, by leaving doors or windows open; religious fears of retribution for being immoral; perfectionism, a fear of not being the best. For sufferers of OCD, these thoughts occur over and over again.
Some sufferers of OCD adopt cognitive strategies to deal with their obsessions. For example, suffers with religious obsessions may pray over and over, to reduce their feelings of being immoral. Furthermore, sufferers of OCD know that their obsessions and compulsions are irrational and experience selective attention directed towards the anxiety‐generating stimuli (similar to the selective attention found in phobias).
Issues and debates
Because of a lack of cross‐cultural statistics on these disorders, most of the research and information comes from organisations based in Western cultures, which inevitably leads to an ethnocentric bias.
There is an aspect of environmental determinism in that phobias and OCD especially can be seen as learned responses to stress triggers. Phobias and OCD both allow for stress reduction, the first by avoidance and the second through obsessive rituals.
Possible exam questions
Define what is meant by the term ‘phobia’. (2 marks)
What is the difference between an obsession and a compulsion? (2 marks)
Explain the difference between behavioural, emotional and cognitive characteristics. (2 marks)
Deborah has been feeling unwell recently and has gone to see her doctor to report her most persistent symptoms. Emotionally, she is feeling empty and that she has a lack of control over her anger which she is directing towards her husband. Lately, she has noticed that she has much less energy to do the usual day‐to‐day activities and she has even stopped enjoying her favourite pastime of gardening. She has started to think that things will never change and that she will always feel like this. Identify what mental disorder is the doctor most likely to diagnose Deborah as suffering from and justify your choice. (3 marks)
Briefly outline the behavioural characteristics of obsessive compulsive disorder (OCD). (3 marks)
Outline the cognitive characteristics of either depression or phobias. (3 marks)
Outline the characteristics of depression. You may refer to behavioural, emotional and/or cognitive characteristics in your answer. (4 marks).
Outline the characteristics of obsessive compulsive disorder (OCD). (4 marks)
Outline the behavioural, emotional and cognitive characteristics of any one of the following mental health disorders: depression, phobias, obsessive compulsive disorders. (6 marks)