Introduction to Psychological Disorders
Senior 6 · Psychology
Introduction to Psychological Disorders
Lesson 2 of 5
25 min
Claudine, 20, is on a packed bus to Nyabugogo when, without warning, her heart begins to pound. She cannot get her breath, her hands tingle, the bus seems to tilt, and she is sure she is having a heart attack. At the health centre all her tests are normal. Two weeks later it happens again in the market, and now she avoids buses and crowds altogether, walking for an hour to work. (An illustrative case.)
Claudine has had panic attacks, and her fear of having more is beginning to shrink her life. Anxiety disorders are the most common group of mental disorders in the world: the World Health Organization estimates that they affected 470 million people in 2023. They are also among the most treatable, although only about one person in four with an anxiety disorder receives treatment.
Definition
Fear: an emotional response to a threat that is present now. Anxiety: apprehension about a threat that may come in the future.
Anxiety disorder: fear or anxiety that is excessive for the situation, lasts (typically six months or more), and causes significant distress or interferes with daily life.
Panic attack: a sudden surge of intense fear that peaks within minutes, with symptoms such as a pounding heart, breathlessness, dizziness, trembling and a fear of dying or losing control.
Obsession: a recurring, unwanted thought, image or urge that causes anxiety. Compulsion: a repetitive behaviour or mental act that a person feels driven to perform to reduce that anxiety.
Trauma (as used for PTSD): exposure to actual or threatened death, serious injury or sexual violence, directly, as a witness, or by learning that it happened to someone close.
| Disorder | Key features | Example |
|---|---|---|
| Generalised anxiety disorder (GAD) | Excessive, hard-to-control worry about many things, on most days for at least six months, with restlessness, fatigue, poor concentration, irritability, muscle tension or poor sleep | Constant worry about money, health, exams and family, even when things are going well |
| Panic disorder | Repeated unexpected panic attacks, followed by at least a month of worry about further attacks or of changing behaviour to avoid them | Claudine |
| Specific phobia | Marked, persistent fear of a specific object or situation, out of proportion to the danger, which is avoided or endured with intense fear | Fear of injections so strong that a person refuses vaccination |
| Social anxiety disorder | Intense fear of situations in which one might be watched and judged, such as speaking in class | A student who skips presentations, though well prepared |
| Agoraphobia | Fear and avoidance of places where escape might be hard or help unavailable: crowds, public transport, open markets | Claudine's avoidance of buses and crowds |
| Obsessive-compulsive disorder (OCD) | Obsessions and/or compulsions that take up much time (often over an hour a day) or cause marked distress | Fear of contamination with washing for hours; repeated checking that the door is locked |
| Post-traumatic stress disorder (PTSD) | After trauma, for more than a month: intrusions (flashbacks, nightmares), avoidance of reminders, negative changes in thoughts and mood (guilt, numbness), and changes in arousal (being easily startled, poor sleep, irritability) | A road-accident survivor who has flashbacks and cannot ride a motorbike again |
In the DSM-5 (2013), OCD and PTSD were moved out of the anxiety disorders into their own chapters, "obsessive-compulsive and related disorders" and "trauma- and stressor-related disorders", although anxiety is central to both. The WHO's ICD-11 also recognises complex PTSD, which adds long-lasting problems with emotion, self-image and relationships, often after prolonged or repeated trauma.
The 2018 Rwanda Mental Health Survey (Rwanda Biomedical Centre) interviewed 19,110 people aged 14 to 65. In the general population, 8.1% had panic disorder and 3.6% PTSD. Among the 1,271 survivors of the 1994 Genocide against the Tutsi who were interviewed, 27.9% had PTSD and 26.8% panic disorder, more than 24 years after the Genocide. These figures show the long reach of trauma, and why trauma-informed care, community support and access to services matter so much. They describe a heavy burden; they do not mean that survivors are defined by it, and many have rebuilt lives of great strength.
Biological. Anxiety disorders run in families; twin studies suggest that genes account for roughly 30 to 40% of the differences between people in risk of GAD and panic disorder. The amygdala, the brain's threat detector, tends to be more reactive, and the neurotransmitters GABA and serotonin are involved.
Behavioural. O. Hobart Mowrer's two-process model (1947) says phobias are acquired by classical conditioning (a neutral stimulus is paired with fear) and maintained by operant conditioning: every time the person avoids the feared thing, anxiety drops, so avoidance is negatively reinforced and the fear is never unlearned. The classic case is John Watson and Rosalie Rayner's (1920) "Little Albert", an infant conditioned to fear a white rat by pairing it with a loud noise. Evaluate: one child, poorly controlled, never deconditioned, and ethically unacceptable today; no proper replication exists. Martin Seligman's idea of preparedness (1971) adds that we learn some fears (snakes, heights, the dark) far more easily than others, perhaps because they threatened our ancestors.
Cognitive. David Clark's (1986) model of panic proposes that people with panic disorder catastrophically misinterpret normal bodily sensations, which creates a vicious circle (Figure 1). In OCD, Paul Salkovskis (1985) argued that the problem is not having intrusive thoughts (almost everyone has them) but believing they are dangerous and that one is responsible for preventing harm.
Figure 1. Clark's (1986) cognitive model of panic. Normal bodily sensations are misread as signs of disaster, which raises anxiety and makes the sensations stronger. Cognitive behavioural therapy breaks the circle at the catastrophic thought.
Trauma. Only a minority of people exposed to trauma develop PTSD. Risk rises with the severity of the trauma, earlier trauma, lack of social support afterwards and further stress, a clear example of the diathesis–stress model.
CrashCourse: "OCD and Anxiety Disorders: Crash Course Psychology #29" (about 10 minutes). It covers GAD, panic, phobias and OCD, and the learning, biological and cognitive explanations. Note which explanations it says are combined in modern treatment.
Important
Where to get help in Rwanda. If you, or someone you know, is struggling, talk to a trusted adult (a parent, teacher or school counsellor) and visit your local health centre. The Rwanda Biomedical Centre asks people to call its toll-free number 114 with questions about its services or in an emergency. Asking for help is a sign of strength, not weakness.
Warning
"I'm so OCD" is not a casual phrase. Liking a tidy desk is not obsessive-compulsive disorder, which can take hours a day and cause great suffering. Using diagnoses as jokes trivialises them and adds to stigma. Similarly, avoid calling someone "traumatised" or "paranoid" loosely.
Tip
PTSD symptoms: "I AM A" survivor. Intrusions, Avoidance, negative changes in thoughts and Mood, Arousal. For any anxiety disorder in an essay: features, a biological and a psychological explanation, and an evidence-based treatment.
Practice
Sources and credits
Written by Ganzaa: the text, the diagram (Figure 1), the table and the exercises.
