Chapter 4: Diagnosis & Prediction: Deviant and Criminal Behavior

any of a group of disorders that have as their central organizing theme the emotional state of fear, worry, or excessive apprehension. This category includes, for example, panic disorder, various phobias (e.g., specific phobia, social phobia), and generalized anxiety disorder. Anxiety disorders have a chronic course, albeit waxing and waning in intensity, and are among the most common mental health problems in the United States. They may also occur as a result of the physiological effects of a medical condition, such as endocrine disorders (e.g., hyperthyroidism), respiratory disorders (e.g., chronic obstructive pulmonary disease), cardiovascular disorders (e.g., arrhythmia), metabolic disorders (e.g., vitamin B12 deficiency), and neurological disorders (e.g., Parkinson’s disease). Obsessive-compulsive disorder and posttraumatic stress disorder were traditionally considered anxiety disorders; however, they are increasingly considered, as in DSM–5, to be separate, if still related, entities.

the simultaneous presence in an individual of more than one illness, disease, or disorder.

a disorder characterized by recurrent intrusive thoughts (obsessions) that prompt the performance of neutralizing rituals (compulsions). Typical obsessions involve themes of contamination, dirt, or illness (fearing that one will contract or transmit a disease) and doubts about the performance of certain actions (e.g., an excessive preoccupation that one has neglected to turn off a home appliance). Common compulsive behaviors include repetitive cleaning or washing, checking, ordering, repeating, and hoarding. The obsessions and compulsions—which are recognized by affected individuals (though not necessarily by children) as excessive or unreasonable—are time consuming (more than 1 hour per day), cause significant distress, and interfere with functioning. Although OCD has traditionally been considered an anxiety disorder, it is increasingly thought to be in a separate diagnostic category; DSM–5 classifies it under the category obsessive-compulsive and related disorders, along with body dysmorphic disorder, hoarding, trichotillomania, and excoriation (skin-picking) disorderexcoriation-skin-picking-disorder, among others.

a sudden onset of intense apprehension and fearfulness in the absence of actual danger, accompanied by the presence of such physical symptoms as heart palpitations, difficulty breathing, chest pain or discomfort, choking or smothering sensations, sweating, and dizziness. The attack occurs in a discrete period of time and often involves fears of going crazy, losing control, or dying. Attacks may occur in the context of any of the anxiety disorders as well as in other mental disorders (e.g., mood disorders, substance-related disorders) and in some general medical conditions (e.g., hyperthyroidism). Also called anxiety attack. See also cued panic attack; situationally predisposed panic attack; uncued panic attack.

an anxiety disorder that is characterized by extreme and persistent social anxiety or performance anxiety and that causes significant distress or prevents participation in social activities. The feared situation is most often avoided altogether or else it is endured with marked discomfort or dread. Also called social anxiety disorder.

in DSM–IV–TR, a disorder that may result when an individual lives through or witnesses an event in which he or she believes that there is a threat to life or physical integrity and safety and experiences fear, terror, or helplessness. The symptoms are characterized by (a) reexperiencing the trauma in painful recollections, flashbacks, or recurrent dreams or nightmares; (b) avoidance of activities or places that recall the traumatic event, as well as diminished responsiveness (emotional anesthesia or numbing), with disinterest in significant activities and with feelings of detachment and estrangement from others; and (c) chronic physiological arousal, leading to such symptoms as an exaggerated startle response, disturbed sleep, difficulty in concentrating or remembering, and guilt about surviving the trauma when others did not (see survivor guilt). Subtypes are chronic posttraumatic stress disorder and delayed posttraumatic stress disorder. When the symptoms do not last longer than 4 weeks, a diagnosis of acute stress disorder is given instead. Changes in PTSD criteria from DSM–IV–TR to DSM–5 include the following: Exposure to the traumatic event may be secondhand if the event happens to a loved one or if there is repeated exposure to aversive details (e.g., as with first responders cleaning up after a disaster); the subjective criterion requiring that the person feel fear, terror, or helplessness has been eliminated; symptom clusters have been recategorized, with additional symptoms; and separate criteria have been developed for children age 6 years or younger.

the normal apprehension experienced by a young child when away (or facing the prospect of being away) from the person or people to whom he or she is attached (particularly parents). Separation anxiety is most active between 6 and 10 months of age. Separation from loved ones in later years may elicit similar anxiety.

an anxiety disorder, formerly called simple phobia, characterized by a marked and persistent fear of a specific object, activity, or situation (e.g., dogs, blood, flying, heights). The fear is traditionally defined as excessive or unreasonable and is invariably triggered by the presence or anticipation of the feared object or situation, which is either avoided or endured with marked anxiety or distress. In DSM–IV–TR, specific phobias are classified into five subtypes: (a) animal type, which includes fears of animals or insects (e.g., cats, dogs, birds, mice, ants, snakes); (b) natural environment type, which includes fears of entities in the natural surroundings (e.g., heights, storms, water, lightning); (c) blood-injection-injury type, which includes fears of seeing blood or an injury and of receiving an injection or other invasive medical procedure; (d) situational type, which includes fear of public transportation, elevators, bridges, driving, flying, enclosed places (see claustrophobia), and so forth; and (e) other type, which includes fears that cannot be classified under any of the other subtypes (e.g., fears of choking, vomiting, or contracting an illness; children’s fears of clowns or loud noises). DSM–5 retains these subtypes, but it omits the traditional characterization that each fear type must be excessive or unreasonable to meet diagnostic criteria, stipulating instead that the fear must arise out of proportion to the actual danger posed by the feared object or situation or to its context. A fear of loud noises, for example, would be considered understandable if experienced in the context of a war zone and thus would not qualify as a specific phobia.

in DSM–IV–TR and DSM–5, a mood disorder characterized by persistent sadness and other symptoms of a major depressive episode but without accompanying episodes of mania or hypomania or mixed episodes of depressive and manic or hypomanic symptoms. Also called major depression.

a major depressive episode or, less commonly, minor depressive disorder that affects some women within 4 weeks to 6 months after childbirth.

any of a group of mood disorders in which symptoms of mania and depression alternate. In DSM–IV–TR and DSM–5, the group includes primarily the following subtypes: bipolar I disorder, in which the individual fluctuates between episodes of mania or hypomania and major depressive episodes or experiences a mix of these: bipolar II disorder, in which the individual fluctuates between major depressive and hypomanic episodes; and cyclothymic disorder. The former official name for bipolar disorders, manic-depressive illness, is still in frequent use.

a period characterized by elevated, expansive, or irritable mood, often with several of the following symptoms: an increase in activity or psychomotor agitation; talkativeness or pressured speech; flight of ideas or racing thoughts; inflated self-esteem or grandiosity; a decreased need for sleep; extreme distractibility; and intense pursuit of activities that are likely to have unfortunate consequences (e.g., buying sprees, sexual indiscretions). In DSM–IV–TR and DSM–5, a distinguishing criterion between a manic and a hypomanic episode is their duration, with manic episodes lasting at least a week and hypomanic episodes lasting at least 4 consecutive days. One or more manic episodes are characteristic of bipolar disorder.

in DSM–IV–TR and DSM–5, a personality disorder characterized by a long-standing pattern of instability in mood, interpersonal relationships, and self-image that is severe enough to cause extreme distress or interfere with social and occupational functioning. Among the manifestations of this disorder are (a) self-damaging behavior (e.g., gambling, overeating, substance use); (b) intense but unstable relationships; (c) uncontrollable temper outbursts; (d) uncertainty about self-image, gender, goals, and loyalties; (e) shifting moods; (f) self-defeating behavior, such as fights, suicidal gestures, or self-mutilation; and (g) chronic feelings of emptiness and boredom.

in DSM–IV–TR and DSM–5, a personality disorder with the following characteristics: (a) a long-standing pattern of grandiose self-importance and an exaggerated sense of talent and achievements; (b) fantasies of unlimited sex, power, brilliance, or beauty; (c) an exhibitionistic need for attention and admiration; (d) either cool indifference or feelings of rage, humiliation, or emptiness as a response to criticism, indifference, or defeat; and (e) various interpersonal disturbances, such as feeling entitled to special favors, taking advantage of others, and inability to empathize with the feelings of others. [originally formulated by psychoanalysts Wilhelm Reich (1897–1957), Otto Kernberg (1928–  ), and Heinz Kohut (1913–1981) and psychologist Theodore Millon]

the presence of a chronic and pervasive disposition to disregard and violate the rights of others. Manifestations include repeated violations of the law, exploitation of others, deceitfulness, impulsivity, aggressiveness, reckless disregard for the safety of self and others, and irresponsibility, accompanied by lack of guilt, remorse, and empathy. The disorder has been known by various names, including dyssocial personality, psychopathic personality, and sociopathic personality. It is among the most heavily researched of the personality disorders and the most difficult to treat. It is included in both DSM–IV–TR and DSM–5.

in DSM–IV–TR, a persistent pattern of behavior that involves violating the basic rights of others and ignoring age-appropriate social standards. Specific behaviors include lying, theft, arson, running away from home, aggression, truancy, burglary, cruelty to animals, and fighting. Specifications for the disorder from DSM–5 include callousness, lack of guilt, and a shallow affect. CD is distinguished from oppositional defiant disorder by the increased severity of the behaviors and their occurrence independently of an event occasioning opposition. Attention-deficit/hyperactivity disorder frequently coexists with or is misdiagnosed as conduct disorder.

in DSM–IV–TR, a personality disorder characterized by (a) pervasive, unwarranted suspiciousness and distrust (e.g., expectation of trickery or harm, overconcern with hidden motives and meanings); (b) hypersensitivity (e.g., being easily slighted or offended, readiness to counterattack); and (c) restricted affectivity (e.g., emotional coldness, no true sense of humor). The diagnosis has been retained in DSM–5.

a personality disorder characterized by long-term emotional coldness, absence of tender feelings for others, lack of desire for and enjoyment of close relationships, and indifference to praise or criticism and to the feelings of others. The eccentricities of speech, behavior, or thought that are characteristic of schizotypal personality disorder are absent in those with schizoid personality disorder. It is included in both DSM–IV–TR and DSM–5.

in DSM–IV–TR and DSM–5, a personality disorder characterized by a pattern of long-term (rather than episodic) self-dramatization in which individuals draw attention to themselves, crave activity and excitement, overreact to minor events, experience angry outbursts, and are prone to manipulative suicide threats and gestures. Such individuals appear to others to be shallow, egocentric, inconsiderate, vain, demanding, dependent, and helpless. The disorder was formerly known as hysterical personality disorder.

a personality disorder characterized by various oddities of thought, perception, speech, and behavior that are not severe enough to warrant a diagnosis of schizophrenia. Symptoms may include perceptual distortions, magical thinking, social isolation, vague speech without incoherence, and inadequate rapport with others due to aloofness or lack of feeling. It is included in both DSM–IV–TR and DSM–5.