Author: Mark Moran

DSM-V-TR and Personality Disorders

Posted on by Mark Moran

Personality Disorders are one of the more interesting types of disorders in mental health.  They attract the most attention and curiosity about why individuals act the way they do.  For the secular mind, it attempts to explain right and wrong, criminality, oddities, and other quirks that step out of bounds within the social structure.   As observed in early psychology, it a disorder but the mind still has the ability to possess rationale in its own self.  From a religious perspective, it constitutes the reality of brokenness of humanity and how individual acts of deviation can become habitual aspects of one’s personality (McRay, 2016).  These disorders distort personality to such an extent to cause inner personal turmoil in one’s feelings towards others and one’s assertion of those feelings outside the norms of one’s cultural context (McRay, 2016).   For this reason, many personality orders are not only odd, eccentric, selfish, rude, and withdrawn, but also violent and terrifying to others.

Personality without empathy or ability to properly feel, think and act within the context of its cultural norm is considered disordered. Please also review AIHCP’s Healthcare Certifications

Personality in itself is an essential feature to a person.  It involves a person’s overall demeanor, it includes how a person reacts internally and externally with others and the person’s overall temperament.   Overall, a personality is one’s unique patterns of thinking, acting and feeling (Myers, 2019).  There are numerous theories of personality ranging from the psycho-analytic schools to the humanistic as well as the behavioral schools of psychotherapy.  All emphasize their targeted areas of study to the development of personality and all add unique elements to understanding personality.  Within personality, exist various traits that are essential to proper functioning within the norms of society.  Traits are  characteristics or behaviors or dispositions of how a person feels or acts in certain ways (Myers, 2019).  Experts list the Big Five Factors of traits that determine personality factors.  Myers lists Conscientiousness, Agreeableness, Neuroticism, Openness and Extraversion (2019).  When one sways from one extreme to the other in these traits, then imbalance occurs.  In addition, the DSM-V-TR also lists these traits in its alternate diagnosis for personality disorder with openness being replaced with lucidity (2022).

When an individual deviates from the cultural norms of his or her culture and society and these extremes manifest against the core basic traits, one will witness odd or deviated social behavior, but isolated acts of misconduct or erratic behavior do not constitute a disorder.  A disorder is far more deeper and its duration long lasting.  In this blog, we will take a closer look at personality disorders and their striking deviations from cultural norms and behavior.

Please also review AIHCP’s Healthcare and Behavioral Healthcare Certifications

What is a Personality Disorder?

The DSM-V-TR points out that an enduring pattern of inner experience and behavior that deviates from expectations of one’s culture constitutes a personality disorder.  These disorders manifest in one or two ways, via cognition, affectivity, interpersonal functioning or impulse control.   The DSM-V-TR continues that these enduring patterns are inflexible and pervasive across the range of the person’s personal and social situations and interactions with others (2022).   The DSM-V-TR states that these behaviors cause significant distress and impairment in social and personal relationships and this pattern remains stable and of long duration with origins in adolescence and early adulthood (2022).  Obviously, these issues are not related to substance abuse, medication, or other mental defects.

The DSM-V-TR looks at moderate to severe impairment in traits to affect identity, self-direction, empathy and intimacy.  In addition, these disorders can portray various distortions of personality traits to the extreme.  They can manifest negative affectivity versus emotional stability, detachment versus extraversion, antagonism versus agreeableness, disinhibition versus conscientiousness, and psychoticism versus lucidity (2022).  It is because of this one can witness in personality disorders a wide range of odd, eccentric, emotional, impulsive, egocentric, aggressive, violent, unempathetic, and manipulative traits.

The DSM-V-TR groups personality disorders into three clusters.  Cluster A includes paranoid disorders such as paranoid, schizoid and schizotypal.  Cluster B includes personality disorders such as anti-social (sociopathy/psychopathy), borderline personality disorder, histrionic, and narcissistic disorders.  Finally, Cluster C includes avoidant personality disorders such as avoidant, dependent and obsessive compulsive personality disorders (not to be confused the OCD itself). (2022).

Of particular note, based on different case studies and surveys, the percentage of personality disorders within the general population is 9 to 10 percent suffering from some type of personality disorder in some degree or level (Barlow, et al. 2023).  Ironically, many of the terms associated with these disorders, are used loosely in everyday vernacular towards individuals who may act a certain way in a given situation but not possess the disorder.  Bad behavior, sin, vice, or whatever one wishes to label it is part of the human condition and people are not perfect.  Personality Disorders are merely a persistent form of these behaviors at an extreme and rigid level.  So, when diagnosing, anyone at some time or some point can see at least a couple undesirable traits and feel guilt or shame for exhibiting these actions.  Ultimately guilt and shame and acknowledgement are key signs one does not possess the disorder itself.

Types of Disorders

Personality Disorders are divided into three clusters of paranoid, anti-social and avoidant

Paranoid

Paranoid personality disorders are in the realm of psychotic and the schizotypal form can sometimes be the premorbid phase of schizophrenia itself.   One of the key elements is the disorder is persistent before and after any delusional of psychotic episodes.

Paranoid Personality Disorder constitutes a pervasive distrust and suspicion of others.  Without evidence, they feel they are being exploited or harmed.  They discover unfounded evidence of demeaning actions or threatening meanings in other individual’s remarks or cues.  They are preoccupied with doubts of other’s loyalty to them and find it difficult to confide in others.  They feel information can constantly be used against them.  Emotionally, they can become angry and hold grudges due to the perceived threats (DSM-V-TR, 2022).

Schizoid Personality Disorder is a detachment from social relationships beyond intimate family.  They also possess a restricted range of emotions.  These traits continue before and after remission of possible psychotic episodes (DSM-V-TR, 2022).   Schizotypal Personality Disorder is more severe and resembles Schizophrenia and other schizophrenic spectrums.  It can also co-exist with them but also exists outside the psychotic psychotic episodes (2022).

Anti-Social

Anti-Social Personality Disorder is best known a pervasive and consistent pattern of disregard and violation of the rights of others, occurring since age 15  and must be at least 18 (DSM-V-TR, 2022).  With diagnosis, three of the following traits must persist

  1. failure to comply with social norms and laws
  2. deceitfulness and pathological lying
  3. impulsiveness and failure to plan
  4. irritability and aggressiveness
  5. recklessness and disregard for safety of self or others
  6. consistent irresponsible behavior
  7. lack of remorse or empathy
Anti-Social Personality lacks empathy and recognition of the rights of others

The DSM-V-TR continues in alternative diagnosis with emphasis on a distorted identity based on egocentrism and self-esteem deprived via power and gain and pleasure.  Personal gratification is the primary goal and self direction absence of inhibitions that prevent those gratifications.  There is a lack of emotional connection or empathy within the disordered person and intimacy and relationships are meant for exploitation or manipulation to meet one’s own needs.   The DSM-V-TR in addition lists these traits of which 6 must be met

  1. manipulation (antagonism)
  2. callousness (antagonism)
  3. deceitfulness (antagonism)
  4. hostility (antagonism)
  5. risk taking (disinhibition)
  6. impulsivity (disinhibition)
  7. irresponsibility (disinhibition)

Horrifying enough, there can be a psychotic specifier as well with psychopathic features which would constitute the differences between a sociopath and a psychopath.  Depending on degree and opportunity, these individuals can be very dangerous in what they are willing or not willing to do to others.  Many criminals possess these traits and those in trouble with the law.  Many can understand something is wrong but fail to care or display empathy or guilt or emotion regarding their actions.

Narcissistic Personality Disorder is commonly comorbid with Anti-Social Personality Disorder.  Narcissists, according to the DSM-V-TR, display a pattern of grandiosity.  They require admiration and lack empathy.  The disorder can manifest in early adulthood (2022).  Five or more of the following are necessary for diagnosis.

  1. grandiose self importance
  2. fantasies of unlimited success, power and brilliance
  3. believes oneself is special
  4. requires admiration of others
  5. sense of entitlement
  6. interpersonally exploitative
  7. lacks empathy
  8. envious of others
  9. severe arrogance

In regards to identity, they require excessive reference of others for self-definition.  Deep down, they have lower self-esteems and without these appraisals, they can suffer emotionally.  In addition, self direction is tied to gaining approval of others.  Relationships and intimacy are more superficial as to the image it portrays.  Empathetically, they are restricted in understanding the needs and emotions of others at the expense of their own (DSM-V-TR, 2022).  Closely related is Histrionic Personality Disorder which faces excessive emotionality and seeking of attention (DSM-V-TR, 2022).

If the other anti-social disorders are more intellectual, then Border Line Personality Disorder (BPD) is the chaos of emotion.  According to the DSM-V-TR, BPD is a pervasive pattern of instability in regards to relationships, self-image and affects which onsets in early adulthood (2022).  Five or more attributes must be present.

  1. frantic efforts to avoid real and imagined abandonment
  2. pattern of unstable and intense interpersonal relationships
  3. identity disturbance and unstable self-image
  4. impulsivity with spending, sex, substance abuse, reckless driving or binge eating
  5. recurrent suicidal behavior, gestures, threats or self mutilation
  6. affective instability due to marked reactivity
  7. chronic emptiness
  8. inappropriate anger or controlling anger
  9. transient stress related paranoid ideation

In regards to identity, BPD is marked by poorly developed and unstable self-image.  Self direction consists of instability with goals and plans.  Empathetically, individuals have a difficult time recognizing the feelings and needs of others.  In regards to intimacy and relationships, there is a consistent intense, unstable and constant conflict with others (DSM-V-TR, 2022).  They experience intense emotional lability, anxiousness, separation insecurity, depression, impulsiveness, risks and hostility (DSM-V-TR, 2022).

Avoidant

Avoidant disorders

Avoidant personality disorders include Avoidant Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder.

Avoidant Personality Disorder involves more than an introvert life style or bouts with anxiety but a pervasive pattern of social inhibition, inadequacy,  and hypersensitivity to negative evaluations of self (DSM-V-TR, 2022).   Four or more of the following are need in diagnosis.

  1. avoids occupational activities
  2. unwilling to get involved with others unless certain of being liked
  3. restraint with intimiate relationships
  4. preoccupied with fear of rejection
  5. feelings of inadequacy
  6. views oneself as unappealing, inferior or inept
  7. avoids risks of engagement or new activities

Avoidant personalities are associated with low self esteem identity wise.  Their self direction is distorted due to reluctance to pursue goals.  Their empathy for others is distracted by their own internal fears and their intimacy is restricted due to shame and fear of rejection.  Their traits include anxiousness, withdrawal, anhedonia and intimacy avoidance (DSM-V-TR, 2022).

Dependent Personality Disorder involves a pervasive or excessive need to be taken care of by others which leads to submission and clinging behaviors marked by separation anxiety which manifests in early adulthood (DSM-V-TR, 2022). Five or more of the following symptoms are required for diagnosis.

  1. difficulty making everyday decisions without excessive advice and reassurance
  2. needs other to assume responsibility in life
  3. difficulty expressing disagreement
  4. difficulty initiating projects
  5. goes to excessive lengths for reassurance
  6. feels helpless when alone
  7. seeks relationships for security
  8. fearful of abandonment

Finally, Obsessive Compulsive Personality Disorder concludes the avoidant disorders.  This disorder is not to be confused with OCD which can be comorbid but unlike OCD which reacts to stressors and anxiety, OCPD exists in all situational relationships.  According to the DSM-V-TR, it is represented by a pervasive pattern of preoccupation with order, perfection and mental and interpersonal control at the expense of flexibility which begins in early adulthood (2022).  Four or more of the following symptoms are necessary for diagnosis

  1. preoccupation with details, rules, lists, order, schedules, organization
  2. perfectionism derails task completion
  3. focused on work before any types of leisure
  4. overconscientious, scrupulous and inflexible in matters of morals, ethics or values (not when accounted to religious or cultural identification)
  5. unable to discard worthless objects
  6. reluctant to delegate tasks to others
  7. adopts miserly spending habits
  8. rigid and stubborn

Those with OCPD compose their identity as correlated with work or productivity.  Their self direction is complicated due to rigidity in completing tasks and meeting standards.  They lack difficulty in empathy to understand the feelings and standards of others.  Finally, their intimacy is restricted in relationships since they put relationships secondary to work and maintain a rigid and stubborn life with others (DSM-V-TR, 2022).  They adhere to rigid perfectionism, perseveration in tasks, intimacy avoidance, and possess restricted affectivity (DSM-V-TR, 2022).

Etiology and Treatment

Personality disorders are both a product of nature and nurture with roughly 10 percent of the population suffering from them

Personality Disorders like all mental pathologies cannot be originated from one aspect of life but is a culmination of biological, genetic, psychological, behavioral and social factors.  In addition, many possess comorbid mood disorders or maladaptive coping strategies involving substances.  In the cases of Anti-Social Personality, it is obvious that there are genetic dispositions as well as biological deformities within the brain that restrict empathy and impulsivity (Barlow, et al., 2023).   In addition, early childhood mistreatment, abuse, trauma, poverty and malnutrition can play roles in the development of life views and emotional affectivity (McRay, 2016).   None of these things guarantee a disorder, but they collectively can contribute to disorders that later develop in early adulthood.

In children, values and morality are also essential to enforce in life.  In early development of a children, egocentrism is important to survival but children are exposed to empathy, love and the needs of others.  Children that are not properly guided can develop vices that later can lead to habitual life styles (McRay, 2016).   Children with natural inclinations to pride, or selfishness, or other vices, without the proper guidance can fall victim to these inclinations as adolescence continues.  These maladaptive behaviors manifest as the person is permitted without consequence to perform these actions.  Obviously from a religious perspective, morality and restrictions are essential guardrails in anti-social personality development (McRay, 2016).   Even without proper social norms and concepts such as the Golden Rule, individuals can develop into habitual disordered individuals in mind, thought, emotion and behavior.

Unfortunately, many individuals with personality disorders do not seek treatment.  Avoidant groups are the most likely to seek help but anti-social and paranoid seek assistance less.  Those who do find help require extensive and consistent counseling that focuses on emotional regulation, identifying distorted thinking, and understanding the needs of others.  This involves comprehensive psychotherapy that includes CBT, DBT and other cognitive therapies.  Humanistic therapies can attempt to at least encourage acknowledgement of the needs of others.  Medication is rarely helpful but only to alleviate secondary symptoms of anxiety or depression, especially in BPD (Barlow, et al., 2023).

Pastoral and Christian Counseling care has existed well before modern psychology.  In these practices, the proposed opposite virtue of the habitual vice was emphasized such as humility over pride or temperance over anger.  In these cases, the spiritual treatment of the sinful condition was considered in addition to the mental pathology.  Moral virtues, spiritual discipline, submission to God and constant regulation over viceful responses were considered critical.  For many, faith left the change to the grace of God  due to the sinful nature of humanity(McRay, 2016).Too many times, pastoral leaders or even counselors and mental healthcare professionals can become over involved in personality disorder cases looking to rescue and save these clients.  Many of these clients unfortunately are sometimes beyond saving and will attempt to manipulate helpers.

In regards to loved ones, family is encouraged to never withdraw love but to always protect themselves from manipulation or abuse.  In addition, they are to set strong boundaries with those facing personality disorders.  Boundaries are essential and must be made clear and definitive of expectations but also demands for treatment.  Family needs to become psycho-educated on the disorders and be able to identify manipulations or emotional states to better protect themselves but also help the person.

Conclusion

Please also review AIHCP’s Healthcare Certification Programs

Personality Disorders are habitual, persistent, and impairing traits that affect an individual’s ability to show empathy, regulate emotion, or interact with other people in a fair and just way.  The disorders affect their ability to properly assert themselves in positive or negative ways.  They manifest in types or paranoid, anti-social or avoidant.  All individuals to some extent sometimes deviate from the norm or do something wrong, but personality disorders deviate from the cultural norm on a consistent basis and at disproportionate extreme. While those who suffer from these disorders, especially BPD and Sociopathy must be held accountable for bad actions, one still must understand the unnatural impulse that has habitually sidetracked their ability to operate as normal individuals.  This leads to erratic, odd, distant, dysregulated, manipulative, rigid, emotional, or dangerous behaviors.  These disorders have multiple origins from genetics, biology, as well as past trauma, and behavioral upbringing.  It is difficult to predict what factors will lead to a true disorder but roughly 10 percent of the population suffers from a personality disorder.  In regards to treatment, psychopathology and some medications can help alleviate anxiety and depression, but overall, a person must commit to life long therapy and continually identify their issues.  Ironically, the inability to acknowledge this is the biggest issue for adjustment.  Finally, it is important to form healthy boundaries with loved ones who suffer from these disorders.  While many are hard to understand or even tolerate, it is important to remember they are broken.  This does not mean one surrenders oneself to their desires, nor does it mean one justifies their actions or does not hold one accountable, but it does demand an empathetic condition for their brokenness.

Please also review AIHCP’s Healthcare Certification Programs and see if they meet your academic and professional goals.

Additional AIHCP Blogs

Anti-Social Disorders – Access here

Narcissism Video- Access here

Borderline Personality Disorder- Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Personality Disorders. Cleveland Clinic.  Access here

Burton, A. (2024). “The 10 Personality Disorders”. Psychology Today.  Access here

Personality Disorders.  Mayo Clinic.  Access here

Pugle, M. (2026). “10 Types of Personality Disorders”. Very Well Health.  Access here

 

 

Christian Counseling and Spiritual Direction: Balancing Psychological Self-Esteem with Spiritual Humility

Posted on by Mark Moran

Christian Counselors and Spiritual Directors help many individuals coming from deeper issues of loss, trauma, pain, and spiritual darkness that are searching for healing and love in the presence of God.  The dichotomy of Christian theology that expresses the human soul as a child of God but at the same time notates the nothingness of self compared to God is a striking polar opposite.  Obviously, a person in need cannot be declared as nothing and stripped of all goodness that innately exists within their personhood.  With an awakening of self, the spiritual journey and crosses have life has injured many elements of self image and concept, so it is important to elevate self esteem but also eliminate pride.  There lays the delicate balance of understanding and communicating the value of humility but also the praise of self in the healing process.

Humility ironically leads to greatness because it recognizes our dependency upon God

Please also review AIHCP’s Christian Counseling Certification, as well as its Spiritual Direction program

As Creatures

God the Creator, chose to create humanity from nothing due to His infinite love.  As a creatures, it is an essential truth to acknowledge two things.  First, creatures are nothing in comparison to the Creator and second, creatures owe the Creator everything.  God does not wish to force servitude on His creatures, but He is the source of their creation and hence it is only natural and right that creatures worship and adore Him.   This is not due to a sense of entitlement by God, or self-interest and pride in His greatness but a true reality of existence.  When creatures cease to worship and serve the Creator, then their end becomes unnatural.  This unnatural end results in corruption.  Lucifer and his minions rejected this law of nature and instead chose their own will and attempted to alter the natural reality of existence by refusing worship and obedience to the Creator.   The choice did not liberate them from worship but forever corrupted them in pain and suffering.  Since God is infinite love, when one abandons self and seeks God, the act of worship is likened to breathing.  It is natural and just.

As creatures, justice alone suffices to acknowledge the creature’s obligation to serve and worship.  It also clearly points out the dependency and imperfections of the creature in relationship to the Creator.  It would be a delusion of grandeur to glorify one’s stature, talents, appearance, or works as one’s own accomplishments without reflecting the design and influence of the Creator.  This is not a false humility but a reality that every creature must accept as natural.  When a creature attempts to glorify self, it leads to delusion and corruption, but when a creature understands its relation to the Creator, it lives in truth.  Mary, the greatest and most magnificent creature ever created by God, teaches others one’s own nothingness.  At the Annunciation. she responds to the Angel Gabriel’s salutation with a statement of her graceful state as a reflection of God and not of her own doing.

As Children

God transformed creation with His infinite love.  He transformed creatures to His children, from something to someone and ultimately nothing to everything.  God’s love elevates His creatures to children of God.  It is in that relationship that individuals have true identity, self-image, value, and beauty.   God created humanity in His own image and likeness according to Genesis.  In this way, He infused intellect and will.  This permitted His creation to possess a true image of the Divine that possessed sentience and freedom of choice.  It permitted the relationship to be a mutual relationship of love as between parent and child.  In this way, humanity became a prized possession of God, so much, that even after its fall, He was willing to become human, suffer, die and rise to save them from their own folly.  It is through this additional act of love, beyond creation, but also redemption and sanctification that one sees the great value of one single human soul.  The ransom price for each soul at the cross was a heavy price and God gladly paid it through Jesus Christ.

From this, one can see a balance of creature and child.  Nothing and everything.  It is within reflection and acknowledged dependence of the Divine that humanity’s nothingness becomes everything and it is through that a true Christian self esteem can emerge in a directee and spiritual child.  It involves anchoring self-esteem and self-image to the connection with the Divine.

Christian Humility

Since pride corrupts and distorts reality between creature and Creator, then it is important to flee it and foster humility.  Ironically, Scripture points out, the last will become first, and the one who destroys his own life will save it.  These phrases in Christianity all point to a deeper mystery.  It points to the truth that for one to truly find value in self, it is dependent upon complete rejection of self.  This is clearly the opposite message of Lucifer and his fallen temporal world.  The world whispers success at all costs, elevation of self, collection of riches, and exaltation of achievements.   In modern psychology, congruence is seen as self-fulfillment and finding happiness in what one deems to be good.  So many false images of happiness are sought to fulfill one’s own ego and desire in the mirage of temporal happiness only to be illusions that lead to chaos, loss, dissatisfaction, and moral degeneration.  As Lucifer looked to idolize self, and how Adam sought self actualization without God, the temporal and secular man seeks self approval, pleasure and acknowledgement of others.  The demand and adoration of the narcissistic self distorts the reality of creature and attempts to worship self as Creator.  While this may seem subtle and maybe not as dramatic as Lucifer or Adam, the continuation of actions and their temporal gratification and glorification of self create narcissistic qualities that through habit become one’s own deification.  Whether its through social media, fame and fortune or power, the creature becomes intoxicated with self and loses its identity.  This in turn leads to corruption as pride, the source of all sin, leads to further deformity in greed, avarice, lust and envy for more.  It is of no wonder then that creatures then attempt to define their own laws of moral conduct since they have become their own god.

Christian humility is the answer to this disastrous corruption of self.  It is not a degradation of self but is a truthful mirror of a creature in dependence of a Creator.  Like new born babies and infants, Christian humility acknowledges the need of a parent and the inability to exist or succeed without the Divine.  It acknowledges that all accomplishments, successes, fortunes, riches, blessings, talents, virtues, and spiritual progress are God’s grace.  It acknowledges that the creature cannot walk without the gentle guidance of the Creator.   Likening the fallen world to a baby’s crib or playground, the great empires that are built in the creature’s mind are merely tall Lego blocks as compared to omnipotent and eternal presence of God.  To exalt such feeble success to infinite greatness is a folly that Christian humility illuminates.  Christian humility in spiritual direction does not look to tear the person’s success down, or make the person feel insignificant, it seeks to awaken the person from the illusion of the Matrix and to embrace the truth that all good comes from God and not self.  Humility protects the creature from corruption and aligns the creature to reality and truth so that it can grow and become fulfilled as a child of God.  Humility teaches a far greater self value then the self can ever afford for it is supported by a Divine enterprise and loving Father.

When the God, via the Second Person, became incarnated in Jesus Christ, He taught creation these truths.  Jesus highlighted the folly of self adoration and the foolishness of seeking the world before the soul.  Jesus refused the powers afforded to Him by a mere creature, namely Lucifer.  Who in his delusions sought as a creature to afford the Creator power and wealth in a fallen world.  Jesus rejected the pride of Lucifer in the desert and revealed the truth that humility over pride is reality.  Jesus did not grant Himself a rich palace, but instead chose to be born in a stable.  He lived for 30 years under moderate means as a carpenter supporting His mother.  He enjoyed life in its simplicity as a testament to truth of reality.  In His ultimate act of humility, as both God and man, the omnipotent and eternal God, hid Himself in His humanity and permitted the profane hands of creatures to mock and crucify Him.  He stood before the pompus pride of Pilate and permitted this execution to take place, although as Creator, He could at any moment smite the entire Roman legion.  In this humility, He surrendered Himself willing out of love for all His creation to be openly executed.  He never reprimanded them, or exposed His Creatorship but with humility accepted the will of the Father. Christ said to His apostles regarding this fallen world, that if this place rejected Himself, the Creator, it will reject His followers.  He taught them to seek these injustices, these rebukes, and embarrassments and to offer them to God.  These slights should be seen as opportunities to suffer with Jesus and for Him to offer our imperfect deeds to the Father in His name.

In the text, “The Spiritual Combat” by Dom Scupoli, like many writers of his time, there was a great emphasis to acknowledge the nothingness of self.  One sees this in the writings of Avila, as well as Loyola.  Scupoli states that one should completely distrust self and place all trust in the Creator.  In doing so, one accepts the reality that without God, one is truly nothing.  One cannot do a single good deed without the merits of grace earned for oneself by Jesus Christ.  In addition, one should honestly realize that without the gift of love from God, one deserves nothing from God, but nonetheless owes Him everything.  Scupoli points out that pride corrupts the soul and breaks one from the reality of a creature’s true status.   One should then seek the opportunity to be humbled by others and to always reflect one’s accomplishments to God.  In this way, one experiences the truth of reality and avoids the destruction of self glorification.

Self Esteem in Counseling Vs Christian Humility

Christian humility acknowledges God as Creator and source of all our gifts and virtues. Please also review AIHCP’s Christian Counseling Certification and Spiritual Direction Program

While many humanistic counselors may see the degradation of self and one’s inability to do good without the external source of God as undignified, the reality is it prevents the disastrous lies that lead to vice and ultimate maladaptive coping.  Self-esteem is critical for the depressed and broken.  Individuals need to be taught to respect themselves, to love themselves, and to find joy in success.  Counselors help them cultivate the tools to create and meet goals.  It is healthy to find “pride” in accomplishments.    It is also not sinful to accumulate temporal goods and find joy in temporal successes.  However, when the source of one’s self esteem is rooted in self-glorification and one’s own morality and laws, then it becomes untruthful to reality and can cause degradation and misery.  One’s self-esteem must be tied to God.  When tied to God, it is more than it can ever be alone.  One whose self-esteem is tied to God values and loves oneself because God loved oneself first.  One whose self-esteem is tied to God is placed on an objective and unbreakable foundation of Divinity rather than  shaky subjective weak foundation of frail humanity.  Finally, humility with God grants a calm sense of peace in the presence.  Unlike pride which is always moving and self serving, seeking and never content, humility grants peace about the past and security about the future.  Depression of the past or anxiety of the future is tied to pride and not humility.  The humble soul is content and secure in the grace of God because it submits to His will and serves Him.

It is natural than that true self-esteem correlates not with humanistic pride and narcissism, but with Christian humility.  The acknowledgement of weakness and dependency does not weaken self-esteem, but grants it the source of its power through the Creator.  Humility grants to the Creator His reflection and image in the creature.  This humility then elevates the creature beyond any limits imaginable.  This may not translate in this valley of tears as success but it does translate in eternity with Christ by emulating Christ on earth.  Christ’s message of truth was humility because it frees oneself from the illusions of Lucifer.   A great saint once said, the greatest weapon against the devil is humility because he does not know it.

Humility and Psychology

Since humility is so critical to salvation, it is no wonder then that is critical to temporal existence as well.  While counselors help navigate individuals through issues of depression and low self-esteem there needs to remain a balance that does not transgress into narcissistic behavior.  While even secular psychology looks to free the self to find happiness, even it recognizes the dangers of extremes in behavior.  When self esteem becomes narcissistic pride it becomes dysfunctional and socially impedes a person’s mental and emotional progress in life.  In the article, “What Is Humility & Why Is It Important?, Schaffner points out various critical elements of humility in psychology and social interaction.  She points out that humility is key accurate self portrayal, modesty and awareness of others (2020).  In addition, Schaffner lists other key elements of humility which include a willingness to see one’s true self, an understanding of one’s appropriate place in the world, an understanding of one’s faults, limitations and mistakes, a true openness to change, a focus on others, and an ability to appreciate other things outside ourselves (2020).

Like the spiritual benefits, the emotional and psychological benefits seem to both open oneself to others, service, and truth.  Pride that becomes malignant is detrimental to self, growth and society.  Pride becomes an injustice to reality, self and others.   It makes sense than that a Christian perspective on humility is far from detrimental to self-esteem but in reality beneficial.

The Devil and Spiritual Pride

Pride becomes narcissism and creates the illusion of greatness which leads to corruption.

For those who seek God, spirituality opens many doors of illumination and unity with Him.  However, like the souls who seek power in secular venues, spiritual people can befall pride in spiritual endeavors.   Instead of riches and money and fame, the soul boasts of virtue and sanctity and holiness.  Scupoli notes that this is one of the traps of the devil.  Individuals exposed to the world are ensnared differently than individuals seeking spiritual perfection.  Like the Pharisees, spiritual virtue becomes source of power over others.  It becomes their own cultivating gifts instead of a grace given by the Creator.   These souls then find pleasure in their own virtue as a end in itself.  In this pride begins to rot within the soul.   Instead of thanksgiving, gratefulness and humility for grace, the individual gravitates towards holy deeds as their own.  In turn, instead of empathy for others in sin, they find judgement.  Instead of reflection of their own failures and past falls, they only condemn those committing the same offenses.  They feel a sense of entitlement and status and wish for their spiritual sanctity or message to be seen and heard.  They fall into disobedience to spiritual authority and envy others of spiritual status, as well as seek ways to overcome spiritual rivals.  This is the corruption instilled by Satan in spiritual pride.  It utilizes the same schema but unlike utilization in a secular setting, it finds its use in a spiritual one.  This is why Christ was so abrupt with the Pharisees because He understood their rottenness and pride.

Scupoli recommends that individuals flee all vanity in the spiritual life and to recall one’s own distrust of self and complete reliance of God.  While thankful and happy to receive graces from God as any child, he also reminds one to never believe that these gifts are a result of sanctity or worthiness.   He warns one to never find disgust in another’s faults but to remember the same faults that exist in oneself and if not for God’s grace, how one would be no better.  He reminds one that one fails God or sins to not scrupulously over analyze the fall but to seek immediate forgiveness.  When one over analyzes failure, one tends to oppositely attribute success or failure as to one’s own means.  One can never reach perfection.  One is never worthy.  Only through blood of Christ and the ransom paid is one made worthy.  A humble soul participates with Christ but no works or deeds can ever save himself but only through the faith of Christ which produces a living faith of works energized by His grace.  So, no matter how hard one may try to reach Christian perfection, no creature of himself or herself can ever be perfect.  Many sincere souls rightfully fear offending God and seek each day to avoid sin at all costs.  While this is important, it is equally important to understand that one when fails, it is due to our one’s own brokenness and one cannot allow pride to seep in the crevices of thinking one cannot sin.  Humility since it is based in truth is also aware of brokenness and sin as a part of an imperfect nature due to Original Sin.  Hence when sin occurs, one should humbly acknowledge the brokenness and pray harder to God for future graces.  Humility constantly re-directs oneself to God after sin because it acknowledges that oneself cannot live a good life without God’s grace.

Scupoli reminds individuals that sin and suffering and crosses are tools God utilizes to foster humility.  Through failures, the soul realizes even more so its utter dependence upon God.  The moment the soul falsely feels it can move forward of its own devices and virtue, then it is destined for failure via the vice of pride.  In this way, God reminds His children that they need Him, not out of arrogance but out of necessity of reality.

Conclusion 

Work hard, stay humble and reflect all greatness to God in your life. Please also review AIHCP’s Christian Counseling Certification and also its Spiritual Direction Program

Christian humility is not meant to deface self-esteem, or identity.  It is meant to strengthen it through connection with God.  It is based in reality and not the false assumptions and illusions of the world that celebrate arrogance, power, and success over piety, reliance and thanksgiving.  Pride is the great illusion of self where one puts self on a pedestal as god.  It corrupts and destroys like it did to Lucifer.  The great deceiver hopes to trick humanity into being prideful about self and elevating the creature to the level of Creator.  It is not depraving or neglectful to rightfully and truthfully understand one’s nature of dependence upon God.  It does not depress self-esteem but permits self-esteem to actualize itself through the connection of grace with God.  Humility is the tool for this relationship because it, unlike pride, acknowledges the reality between Creator and creation.

Please also review AIHCP’s Christian Counseling Certification as well as its Spiritual Christian Direction program

Additional Blogs

Christian Happiness and God.  Access here

Christian Suffering.  Access here

Reference

Scupoli, D. (1589).  Spiritual Combat (2024 edition). Holy Water Books.

Additional Resouces

Schaffner, A. (2020). “What Is Humility & Why Is It Important? (Incl. Examples)”. Psychology Today.  Access here

“4 things everyone should know about humility”. Active Christianity.  Access here

Johnson, S. “The Vice of Pride”.  Access here

DSM-V-TR and Diagnosis of Schizophrenia Spectrum and Psychosis

Posted on by Mark Moran

When one considers the classical image of mental illness, psychosis, hallucinations and delusions are the first to come to mind.  This can create frightening images or archetypes, or remind individuals of the old asylums of the late 19th and early 20th centuries.   While some of the symptoms of psychosis and schizophrenia can be odd and frightening to some, the reality is most are individuals who are suffering and trying to survive.  1 in 100 individuals suffer from schizophrenia and if exists within family history , the chances of inheriting the gene that activates it rises (McRay, et al., 2016).   With that in mind, more individuals than one would think suffer at some level within the spectrum of Schizophrenia and psychosis related disorders.  This blog will review the DSM-V-TR and its diagnosis of Schizophrenia as well as related disorders.

Psychosis and Schizophrenia causes hallucinations, delusions, negative symptoms and disorganized thought. Please also review AIHCP’s Healthcare Certifications

Please also review AIHCP’s Healthcare Certifications for behavioral health professionals, as well as nurses and other healthcare professionals.

Etiology Behind Psychosis and Schizophrenia

Psychosis itself can occur within any hallucinating drug, substance or meditation.  Those with the genetic predisposition can activate it in life by use of drugs, or enduring various stressors (McRay, et al., 2016).   The disorders have no gender bias and usually occur late in adolescence or early adulthood (Barlow, et al., 2023).    The first phase consists premorbid conditions of cognitive and social impairments, followed by the prodromal phase which exhibits minor psychotic like behaviors for 1 to 2 years.  It can take up to 10 years for one to fully manifest positive and negative symptoms with the deterioration continuing without treatment (Barlow, et al., 2023).

Since Schizophrenia is highly connected to family history, various neurological defects are apparent, including larger ventricles, as well as higher levels of the neurotransmitter dopamine (Barlow, et al., 2023).   For some, the use of drugs, as well as stressors can play a role in activating it.  Finally, fetal exposition to viral infection and different pregnancy complications can play a role (Barlow, et al., 2023).

Schizophrenia Spectrum

There is not merely one type of psychosis, but a full spectrum that illustrates Schizophrenia and psychosis and how it manifests differently at various degrees and durations.  The DSM-V-TR lists the spectrum as consisting of Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, and Psychotic Disorder due to Substance or Medication induced.  Schizotypal Disorder is briefly listed but categorized within personality disorders (DSM-V-TR, 2022).

Within all of these disorders to some extent or level certain symptoms manifest in extremity, duration or presence that are key in differentiating one disorder from another, but within that group of symptoms are clear signs that point to some type of psychosis.  Within the nature of psychosis delusions, hallucinations, negative symptoms and disordered speech and thought are key divisions of psychosis.

Delusions

Hallucinations are a part of psychosis

Delusions are a disorder of thought content (Barlow, et al., 2023). The DSM-V-TR adds that delusions are unable to change or be altered even if conflicting evidence against them is supplied to the person (2023).   Persecutory delusions are beliefs that an individual is being persecuted, or that one is going be harmed or harassed by a group.  Individuals who feel the CIA or FBI is hunting them is a prime example of this type of delusion.  Referential delusions are when the individual believes that certain benign cues, gestures, or comments are directed at them.  Grandiose delusions refer to delusions that entail the person thinking he or she is someone famous or has individual powers not possessed.   Erotomanic delusions entail belief that someone is in love with them, even someone famous.  Nihilistic delusions are strong convictions that a catastrophe will occur and finally Somatic delusions are fears regarding health and organ functioing (DSM-V-TR, 2023).  Furthermore delusions are considered bizarre if the delusion falls out of the category of even possible, such as aliens inserting a chip in someone’s head (DSM-V-TR, 2023). It is important to differentiate strongly held beliefs or convictions from delusions as well as culturally based ideals that may seem odd to others.

Hallucinations 

Hallucinations are perception like experiences that occur without external stimulus (DSM-V-TR, 2023).  They can be auditory or visual and must occur within the range of normal experiences.  The most common hallucination in Schizophrenia is auditory.  Interesting to note, that when individuals experience auditory hallucinations, it the area of the brain associated with speech or Broca’s area that has been shown in experiments to activate instead of the hearing area known as Wernicke’s area.  This is because the voices are actually coming from own’s speech area and not from a true external auditory source (Barlow, et. al. 2023).

Knowing what is real or not real

Those from other cultures or religious traditions, especially within mysticism, are not always considered to be hallucinating.  The DSM-V-TR clearly specifies that these cases need to be evaluated differently than a pure disorder (2023).  Apparitions and voices of a deity should be evaluated to rule out any mental defect but in some cases no defect exists.  Sometimes, a religious experience can possess qualities of a hallucination but the information or message is foreign from the person.  Other times, religious experiences can affect the five senses themselves and are not hallucinations.  It is important for any spiritual message to sometimes undergo rigid investigation to understand if it is from within a person or if filtered into the person through a spiritual source.  Ultimately, how one views these experiences will pend on if one is an atheist or a believer in the spiritual realm. Regardless, they deserve special differential treatment in diagnosis than pure hallucinations before denying it or labeling one with a disorder.

Disorganized Thinking, Speech and Abnormal Motor Control

It is common with psychosis and schizophrenia for many odd cognitive thoughts, reactions, and word salads to emerge within the individual.  This is part of the disorder and inability to process thoughts and reality.  The DSM-V-TR lists a variety of disorganized thinking and speech symptoms, including derailment or loose association where the person switches without logic from topic to topic, or tangentialtions that illustrate completely unrelated answers to questions.  In addition, incoherence can reach such a state where a word salad manifests where the train of thought is impossible to follow (2023).   In other cases, inappropriate affect can emerge in which the person’s emotional responses do not match the question or situation (Barlow, et. al., 2022).

In regards to motor control, some individuals display catotonia or decreased ability to react to stimuli.  It can also manifest in incomplete or no verbal responses such as stupor or mutism.   It is important to note that catatonia symptoms while related to schizophrenia exist, they can also exist in other disorders as well (DSM-V-TR, 2023).

Negative Symptoms

Negative symptoms and inappropriate responses are common in schizophrenia

Positive symptoms such as hallucinations and delusions are directly manifested in psychosis and schizophrenia, but there are also passive or negative symptoms.  Among them are avolition, alogia, anhedonia, asociality, and affective flattening (Barlow, et al., 2022).  Avolition deals with inability or interest to partake in daily tasks.  Alogia refers to the absence of speech.  Anhedonia refers to the indifference to pleasure or activities that are a source of pleasure.  Asociality refers to withdraw and lack of interest of social interaction.  Finally, affective flattening  is a lack of emotional response or a flat affect to questions or a situation (Barlow, et al., 2022).

Diagnosis Criteria of Schizophrenia Spectrum

Delusional Disorder

This disorder requires the presence of at least one type of delusion for the persistence of one month and the delusions must cause social impairments but do not appear as bizarre or as odd of those exhibiting schizophrenia.  These delusions are not due to drugs, substance or other medications and finally,   Hallucinations, negative symptoms and disorganization is rare and any form of catatonia rules out this diagnosis (DSM-V-TR, 2022).

Brief Psychotic Disorder

Brief Psychotic Episode lasts 1 day to 1 month

A brief psychotic disorder exhibits the positive symptoms and is not described by other mental health issues such as major depression or bi-polar.  It lasts a minimum of 1 day to 1 full month and then a full return to premorbid level of functioning (DSM-V-TR, 2022).

Schizophreniform

This disorder possesses all the positive and negative symptoms of schizophrenia but its duration is its key attribute.  It manifests from 1 month to 6 months (DSM-V-TR, 2022).  It is also not attributed to any other mood disorders or drugs, substances or medications.

 

 

 

Schizophrenia

Schizophrenia requires 2 of the following during a period exceeding 1 month.

1.delusions

2. hallucinations

3. disorganized speech

4. grossly disorganized behavior

5. negative symptoms.

Of the above conditions, one must be from delusions, hallucinations or disorganized speech.

In addition to these core psychosis symptoms, there must be significant impairment and functioning with work, social interaction and self care.  These signs must persist beyond 6 months.  In addition, major depressive disorder and bi-polar disorder must be ruled out.  Finally, the disorder must not be due to any drug, substance or medicine. (DSM-V-TR, 2022).

Schizoaffective Disorder

This disorder exhibits psychotic symptoms for a 6 month period while also enduring bi-polar or major depressive disorder must be present through the majority of the schizoaffective disorder.  It can be specified as bipolar, depressive or catatonia (DSM-V-TR, 2022).

Treatment of Psychosis and Schizophrenia Spectrum

Treatment remains very difficult for many because of the numerous side effects, lack of family and social support, and the damaging effects of the illness for self care but it can help alleviate symptoms and help some individuals live normal lives.

Identifying psychosis disorders is important to finding healing and preventing long term harm to self

Medically, since the 1950s, anti-psychotics have proven to be a powerful tool in helping individuals with psychosis and schizophrenia.  Also, referred to as neuroleptics, these drugs are dopamine antagonists that reduce the production of dopamine (Barlow, et al., 2022).  While helping many individuals who suffer from schizophrenia, the medications can also cause numerous side effects from weight gain to fatigue.  Uniquely to schizophrenia, the lowering of dopamine can cause tremor like symptoms similar to Parkinson disease.  Ironically, individuals who take medications to increase dopamine for Parkinson disease can experience schizophrenic like hallucinations (Barlow, et. al., 2022).

In addition to anti-psychotics, interventions are key in helping individuals face their delusions and social struggles.  Psychotherapy can help individuals understand their way of thinking, as well as provide tools and skills to achieve goals in life while facing the struggles associated with the disorder.   In addition, symptom management is essential in identifying warning signs of potential flare ups and when to seek assistance.  Social and family assistance is key to helping individuals find their way.  Those facing these issues must also always refrain from drugs and alcohol due to their condition of possible psychosis but also due to the nature of the medications they are prescribed (Barlow, et al., 2022).  Essentially, it involves not only accepting and discovering that one has this mental disorder but adjusting to a new way of life to manage the symptoms and promote health.  Barlow points out that treatment plans should be integrative and include collaborative psychopharmacology, community treatment access, family psychoeducation, supportive employment and illness management skills (2023).

Conclusion

Psychosis while odd and sometimes scary affects many people.  Hallucinations, delusions, disorganized speech and negative symptoms are the key groupings of symptoms that manifiest with psychosis. Understanding why it happens and identifying the signs is important in controlling it.  It is essential to diagnose and treat before it derails a person’s social, academic, family and professional life. Unfortunately, due to social support, life style change, medicine side effects, and extreme of impairment, many never receive the full help they need.  This leads to many be left to fend for themselves as they become more disconnected from reality.  Many find themselves homeless, unemployed and in and out of the prison system without proper care.

Please also review AIHCP’s Behavioral Health Certifications for healthcare professionals.

Additional Blogs

Stress and Trauma Disorders: Access here

Anxiety Disorders:  Access here

Mood Disorders:  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Gregory, S. (2026). “Understanding care and treatments for schizophrenia”. Mayo Clinic.  Access here

Schizophrenia (2025). Cleveland Clinic.  Access here

Carey, E. (2024). Psychosis. Healthline.  Access here

Psychosis: Causes, Symptoms, and Treatment. WebMed.  Access here

 

Stress Management, Grief Counseling and Trauma Informed Care: Stress & Trauma Induced Disorders

Posted on by Mark Moran

Those in the fields of stress management, grief counseling, or trauma informed care whether clinical or non-clinical are very familiar with the power of stress, loss and trauma on people.  Part of existence is facing struggle and adversity.  Stressors and losses, as well as trauma, negatively affect people and force them to adjust, adapt and show resiliency.  Obviously, when facing a difficult loss or going through a terrible time, or even witnessing something traumatic, the mind and body reacts.  This does not denote pathology but a temporary adjustment to the things, or events that occurred.  It would be unnatural not to be sad or unhappy or distressed when bad things occur.   It is when these things overcome one’s biology, mind and social support systems that they become unnatural.  Instead of finding adjustment, one remains unadjusted through a series of biological or psychological issues that remain persistent.  So while not all stress is bad, and while everyone faces loss, and not everyone faces PSTD despite severe trauma,  there are cases when pathology and disorder occur that transcends the normal window of reaction in terms of severity and extreme.  In these cases, individuals face biological as well as mental problems in adjusting to the issue at hand.  This short blog will examine how stressors, loss and trauma can cause disorders as well as the listed disorders in the DSM-V-TR.

Stressors, loss and traumas are a reality in human existence. Some are able to cope with these things while others face numerous disorders. Ultimately they all negatively affect oneself but to what degree and duration is key in diagnosing a stress related disorder

Please also review AIHCP’s numerous healthcare certifications for nurses as well as behavioral health professionals, including Stress Management Consulting Certification, Grief Counseling and Trauma Informed Care.

Stress, Loss and Trauma

Stress itself is not bad.  It is part of life.  It pushes one to face adversity and overcome it.  Without the push, one would become complacent and not feel the need to improve or provide.  Eustress is a term that reflects this reality (Barlow, et al. 2023).  Every organism faces stress and stressors.  Hans Selye, the Father of Stress Management and the effects of stress on people, pointed out that is sustained stress that gradually breaks down an organism.  He listed the first phase of alarm to the stressor, the second phase as resistance to it, and finally the third phase, if resistance failed, which resulted in exhaustion (Barlow, et al. 2023).  When an organism reaches a state of exhaustion, it then has biologically, psychologically and socially reached all limits to resist the stressor resulting in disease, breakdown or even death.  Chronic stress usually kills over time not immediately but there can be cases when shock and trauma are so great as to cause massive strokes or heart attacks in already vulnerable populations.

Loss is a stressor in itself but loss in itself is not a pathology.  Losses in life can range from the smallest things to the most important things.  One can lose a job, a relationship, a pet, a parent, or spouse or even a child.  These losses, like stressors, vary in degree and intensity based upon numerous subjective elements of the agent or person.  For most, losses are tied to love and because of love, there is a sorrow and pain tied to any disconnection.  This requires a time to heal and readjust but within normal parameters.  It should not impair a person’s ability to live life.  When a person is unable to adjust and the severity and length of the sadness overtakes oneself, then a disorder develops.

While everyone experiences stress and loss, traumatic events do not occur to everyone but a high portion of the population does experience them.  Like any stressor, trauma while objectively seen as severe can be subjective in how a person responds.  The event itself, the experience of the person and its effects play a key role in how a person responds to a particular trauma.   When a trauma response activates within a person, which is natural reaction to any extreme event, the response is meant to be temporary for the moment.  The survival response in the moment exists in the moment.  However, when the survival response becomes a default mode of existence, then disorders such as PTSD emerge.

Mind and Body Response

When stressors or losses or trauma present itself, the body responds.  The autonomic nervous systems activates the sympathetic nervous system and one enters into a state of fight, flight, freeze or fawn (Barlow, et al. 2023).  The danger part of the brain, the amygdala works closely with the hippocampus and hypothalamus to prepare the body for these modes of survival.  The hypothalamic-pituitary adrenocortical axis (HPA) prepares the body for fight or flight or fawn or freeze by inducing states of hyperarousal or hypoarousal to face the threat via injection of cortisol and norepinephrine into the blood stream (Barlow, et al., 2023).  This tightens muscles, redirects blood to the core of the body, raises blood pressure, and heightens the person to the moment to react.  After the event passes, the body returns to a calmer mode within the parasympathetic system.

When individuals are traumatized, they are unable to turn off this reaction and face a variety of issues.  Long term, this can cause numerous health issues, such as hypertension, coronary issues, immune deficiencies, cancer, chronic pain and chronic fatigue (Barlow, et al., 2023).

Types of Stress and Trauma Disorders

The DSM-V-TR lists a variety of disorders directly tied to stressors, losses and trauma.  They are listed in the DSM-V-TR under the chapter “Trauma-and Stressor-Related Disorders”.  The manual states that those who are exposed to traumatic or severe stressful events exhibit in some cases a phenotype which is tied closely to anxiety or fear based issues (2022).  In addition, these encounters lead to anhedonic and dysphoric symptoms.

Among the disorders listed, the DSM-V-TR lists Reactive Attachment Disorder (RAD), Disinhibited Social Engagement Disorder, Posttramatic Stress Disorder, Acute Stress Disorder, Adjustment Disorders and Prolonged Grief Disorder (2022).

Attachment Disorders

In regards to attachment disorders, children who experience poor caregiving at a young age develop various reactionary disorders to other caregivers which if left untreated can hinder social relationships in adulthood.  This includes RAD which makes it difficult for children to form connections with others (McRay, et al., 2016).  Types of attachment behaviors can be avoidant, anxious or disorganized.  Each has its own characteristic which hinders a persons ability to foster proper relationships with others (McRay, et al., 2016).  AIHCP offers more information about attachment disorders in other blogs that you can review at the bottom.

PTSD

PTSD is tied to a severe trauma reaction due to an extreme event. Please also review AIHCP’s behavioral health certifications

In regards to traumatic response, the DSM-V-TR lists a a long list of criteria and symptoms for PTSD.  It states that one must be exposed to actual or threatened death, serious injury or sexual assault in one of the following ways.

  1. Directly experiencing the event in person or as it occurred in others
  2. Learning that an event happened to a family member or close friend
  3. Experiencing the event or exposure to these events repeatedly

In addition, the DSM-V-TR states that the presence of at least one intrusive symptom associated with the event must manifest as

  1. Recurrent or involuntary or intrusive memories of event
  2. Distressing and recurrent dreams
  3. Dissociative reactions like flashbacks
  4. Intense or prolonged psychological distress
  5. Psychological reactions to external or internal cues that trigger a response

In addition, the person avoids persons, place, stimuli or things that remind them of the event to the point of impairment. They avoid past activities, portray lack of interest and diminished interest with others or the ability to experience positive emotions.  The person is also negatively effected in cognitions and moods through inability to remember certain parts of the event, persistent or exaggerated beliefs about oneself or the world or meaning of life due to the event, as well persistent or distorted cognitions about the cause or consequences surrounding the event (APA, DSM-V-TR, 2022).  The person will also experience issues associated with their autonomic nervous system.  The sympathetic and parasympathetic nervous systems are overworked and experience hypervigilance, exaggerated responses, sleep disturbances, as well as problems with concentration (APA, DSM-V-TR, 2022).  PTSD can be specified with either depersonalization, or the separation and detachment from self, or derealization or the feelings that the world around them is unreal.  These symptoms must manifest for longer than a month.

Acute Stress Disorder

Acute stress disorder shares many of the similar diagnosis criteria as PTSD, but it is far less severe and lasts from day 3 to 1 month with symptoms diminishing within that time frame (APA, DSM-V-TR, 2022).

Prolonged Grief Disorder

When grief becomes complicated, it can lead to depression, prolong grief disorder or a mixture.  The key difference is the locus of the melancholy is due to a targeted and specific loss (APA, DSM-V-TR, 2022).    The grief itself is intense and severe and lingers, hampering a person’s ability to function in life.  The duration for diagnosis is 12 months after the loss, 6 months for children (APA, DSM-V-TR, 2022).  Unlike normal grief, it fails to adjust and is accompanied by intense yearning and longing for the deceased with an abnormal level of preoccupation with the loss.  It includes identify disruption, continued shock and disbelief of the loss, intense emotional pain, difficulty with reintegration into life, emotional numbness, a feeling of meaningless and an intense loneliness (APA, DSM-V-TR, 2022).  Of course, many of these feelings are felt within the first days, weeks and months of a loss, as well as sometimes on memorial days of the loss.  This is why the 12 month deadline is so important before any type of diagnosis.

Adjustment Disorders

Adjustment disorders are tied to life stressors and losses.  They illustrate behaviors or emotions that are in response to an identifiable stressor such as a loss, divorce, or loss job.  The marked distress is not proportionate to the severity or intensity of the stressor (APA, DSM-V, TR, 2022).  It is important to rule out natural loss, prolonged grief, as well as other cultural beliefs that can affect how people react to stress.  These adjustment disorders exist within 3 months of the initial stressor

Primary Treatments

Treatment of anxiety and depression or trauma is best met with psychotherapy.  No particular psychotherapy has been proven clinically to be superior or with better results as others but usually a combination of psychodynamic, behavioral and human centered counseling therapeis are key in helping individuals face their issues.  Cognitive Behavioral Therapy is very helpful in helping individuals face distorted thinking and form better behaviors.  Exposure therapies also exist for cases of trauma to help heal the limbic and sympathetic nervous systems.  Included in this is the practice of Eye Movement Desensitization Reprocessing or EMDR. Holistic treatments that focus on meditation, breathwork and hypnosis can help the subconscious heal as well.  Medication wise, numerous SSRIs, limited use of Benzodiazepines, and anti-psychotics can be utilized (McRay, et al, 2016).

Conclusion

Stress induced disorders can impair life and need treatment. Please also review AIHCP’s numerous behavioral health certifications

Helping individuals with stress, anxiety, loss and trauma is part of life.  In a world where bad things happen, individuals are forced to face terrible things.  Some are minor, while some can overwhelm, and still, some that overwhelm can cause pathological disorders.  The diathesis for disorder is based off many subjective issues ranging from biological to psychological to social to cultural and spiritual.  In many cases, these life issues can be faced in a non-clinical fashion but when disorders arise, clinical help is required.  It is important to remember when working in these fields to remain within the scope of one’s practice.

Please also review AIHCP’s Stress Management, Trauma Informed Care and Grief Counseling Programs.

Additional Blogs

Attachment Disorders:  Access here

Complications in Grieving.  Access here

Trauma Informed Care on PTSD/C-PTSD.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Acute Stress Disorder. My Cleveland Clinic.  Access here

Blain, T. 2025). An Overview of Trauma and Stressor-Related Disorders.  Very Well Mind.  Access here

Sherrell, Z. (2024). Types of stress disorders. Medical News Today.  Access here

 

 

Grief Counseling: Mood Disorders and the DSM-V-TR

Posted on by Mark Moran

Mood disorders transcend the usual care of pastoral or non-clinical grief counselors.  Most grief counselors deal with the natural phenomena of loss that follows a natural grief trajectory.  Clinical professionals, who may also be grief counseling certified, deal with pathological issues surrounding mood.  Any instability of extremes, whether due to mania or melancholy can disrupt natural life and harm mental health.   Sometimes, moods can be directly affected by an acute grief or loss and this leads down a trajectory of complications due to grief, while in other cases, there is no triggering loss that causes the pathological mood.  Instead it involves an in-depth investigation into the etiology of the disorder reviewing biological, genetic, psychological, social and spiritual issues to explain the condition.

The DSM-V-TR lists numerous mood disorders ranging from Major Depressive Disorder to Bi-Polar Disorders. Please also review AIHCP’s Grief Counseling Certification

The DSM-V-TR groups together a variety of mood disorders which in this blog will highlight Major Depressive Disorder, Persistent Depressive Disorder and its numerous specifiers, as well as Bi-Polar 1 and Bi Polar 2 disorders and finally, Prolonged Grief Disorder.  It is important to remember that for the pastoral or non-clinical grief counselor, one should have a strong understanding of these mood disorders to help refer clients to the appropriate clinical specialists.  A non-clinical grief counselor cannot diagnose or treat mood disorders but they can be trained to spot these disorders and work with clinical professionals in assuring the necessary therapy and medications are received for the client.

Please also review AIHCP’s Grief Counseling Certification, as well as its numerous other Grief Programs.

Etiology of Mood Disorders

Mood disorders find their etiology from numerous factors.  Biologically, whether mania or melancholic, there is a strong connection of genetic inheritance of these pathologies tied to the neurotransmitters (McRay,2016).   When the neurotransmitter, serotonin, is low, depressive states can exist.  Serotonin is the a critically important neurotransmitter for mood stability (Barlow, et. al., 2023).   In regards to mania, the synapses between neurons fire to fast, and a euphoric state overtakes the person.  This is usually due to higher levels of  the neurotransmitter norepinephrine and lower of levels of serotonin, although higher levels of serotonin can also lead to states of mania (McRay, 2016).

Depression can be caused by an internal trigger but also a stressor or external loss.  Hence unipolar mood disorders can be both have a direct external stimuli as well as an internal disruption.   Many times the diathesis or culmination of internal and external events that overcomes a person to the disorder can be attributed to external factors that activate it.  As similar to anxiety disorders, a loss, or lack of social support in that loss, or distorted cognitive thinking can unravel a person’s natural reactions into a pathological state (Barlow, et. al. 2023).

When considering psychological etiology for mood disorders, many aspects involve self image, cognitive distortions, as well as learned helplessness in situations.    When individuals engage in self negative talk and think the worst, then it can affect a person’s overall mental paradigm.  In addition, when a person feels they have no control or power to prevent bad things from continuing, then the person becomes susceptible to pathological mood disorders (McRay, 2016).  In addition to how one thinks, social and cultural and spiritual aspects play a key role.  A person’s support system is key in any mood stabilization because it determines the foundation one has to face multiple problems before succumbing to the issue.  In addition, culturally and spiritually, how one views loss can play a key role in how one reacts to loss.

As one can see, mood disorders are a complications of genetic but also psychological, social, cultural and spiritual aspects of the person.  Sometimes, the mood disorder, such as depression, has a visible trigger, but other times, it is purely at the chemical level of the brain.  Every individual is different and what causes diathesis and activation of a mood disorder, or even anxiety is not a simple equation but a very complex one.

Mood Disorders and the DSM-V-TR

In this blog, we will follow the order of the DSM-V-TR and how it lists and discusses the nature of mood disorders.  We will primarily focus only on the above mentioned disorders.

Bi Polar I & Bi Polar II Disorder

Polarity of symptoms Depression euthymia mania subsyndromal hypomania. Vector illustration

Bi polar disorders are characterized by cycles of depression and euphoria (mania) with symptoms that can greatly affect one’s ability to function in life (McRay, 2016).   The DSM-V-TR states that mania is a period of abnormal and persistent moods of high levels of energy with the possibility of also irritability which lasts at least 1 week (2022).   During this phase of mania, the DSM-V-TR notes these types of characteristics with three needed for diagnosis or four if the mood is only irritability.

  1. inflated self esteem or grandiosity
  2. deceased need for sleep
  3. more talkative or need to talk
  4. flights of ideas or subjective experiences that are racing through the mind
  5. distractibility
  6. increased goal directive activities that can be social, work, academic or sexually
  7. excessive engagement in activities with high potential for bad outcomes.  Such as foolish business investments, spending sprees or sexual activitiy

The DSM-V-TR continues that these states cause severe impairment to social and occupational functioning and has no association with other psychotic, psychological, substance or medicated purposes (2022).  Within itself, these are conditions for mania, which albeit rare, can exist as an issue alone apart from Bi-Polar I or II.

Ironically, Bi-Polar I does not require a depressive cycle although that is very rare for one not to be present in diagnosis.  When we discuss Major Depressive Disorder and a depressive episode we will list its diagnosis as well which would be utilized with any Bi-Polar disorder.

For Bi-Polar I, as well as Bi-Polar II, the DSM-V-TR provides many specifiers since it affects individuals with so many additional subjective aspects.    It can be mild, moderate, severe, possess psychotic features, be in partial remission or full remission, or also include anxious distress, mixed features, rapid cycling, melancholic features, mood congruent psychotic features or mood incongruent psychotic features, catonia, peripartum or seasonal (2022).

Bi-Polar II differs from Bi- Polar I in that there is no state of mania but there always must be a depressive state.  What replaces mania is referred to hypomania.  Hypomanic episodes shares the same characteristics of mania but not as severe or impairing to the individual (only 4 days as opposed to at least a week) but it still manifests a change in functioning that is not characteristic of the individual when not symptomatic (2022).  In addition, the mood shift is observable by others but not enough to cause extreme distress (DSM-V-TR, 2022).

The primary differing diagnosis factor from Bi-Polar I over Bi-polar II is one has not ever been diagnosed with a true mania state ever in life.

It is important to note, some individuals who suffer from Bi-Polar mood disorders cycle more rapidly than others, with 4 mood shifts a year being considered high but there can be less cycles and individuals can move through them quickly (Barlow, et. al, 2023).

Major Depressive Disorder

While depressive episodes are part of bipolar disorders, the same criteria for Major Depressive Disorder that diagnoses an episode of depression for Bi-Polar disorders is also diagnosis Major Depressive Disorder but without any mania or states of euphoria.  Major Depressive Order can find its origins biologically or also be a reaction to a loss or severe stressor.  It is a unipolar mood disorder without a switching from extremes but a state of melachony

Facing Major Depressive Disorder

According to the DSM-V-TR depressed moods or loss of interest in pleasure must persist for periods of 2 weeks or longer (2022).  Diagnostic characteristics include the following and requires five or more symptoms for diagnosis.

 

  1. Depressed mood for most of the day or nearly everyday.  Feelings of sadness, emptiness and hopelessness
  2. Diminished interest in pleasure
  3. significant weight loss
  4. Insomnia or hypersomnia nearly or everyday
  5. psychomotor agitation that is observable by others
  6. fatigue and lack of energy nearly everyday
  7. feelings of guilt or unworthiness
  8. diminished ability to concentrate or think or make decisions
  9. recurrent thoughts about death, recurrent suicidal ideation without a specific plan or with a plan, as well as suicide attempt

These symptoms impair the individual in all aspects of life and are not due to any other psychological, medical or use of substance (2022).

Like bi-polar mood disorders, Major Depressive Disorder also has specifiers that dictate mild, moderate, severe, with psychotic features, partial or full remission, with anxious distress, mixed features, melancholic features, atypical features, mood congruent or mood incongruent psychotic features, catonia, post partem, or seasonal patterns (SAD) (DSM-V-TR, 2022).

Overall, Major Depressive Disorder is one of the most common mental maladies.  It is considered the common cold of mental health (McRay, 2016).  Women are 2 to 1 more likely to develop it, while Bi-Polar Disorder is equal (McRay, 2016).

Mentally, an individual suffering from depression faces the depressive cognitive triad that perceives negative connotations about self, the world and the future (Barlow, et. al., 2023).

Persistent Depressive Disorder

Persistent Depressive Disorder differs from Major Depressive Disorder in that is lasts longer than the normal minimum of 2 weeks but untreated can persist for months to years to decades.  It is not as intense but it leads to numerous health and mental issues.  Diagnosis requires a consistent 2 year period.  It includes poor appetite or overeating, insomnia or hyperinsomnia, low energy, low self-esteem, poor concentration and feelings of hopelessness, (DSM-V-TR, 20220).  Individuals can also suffer from both Persistent and Major Depressive.

Other Mood Disorders

Other mood disorders include Disruptive Mood Dysregulation Disorders that deal with frustration and anger outbursts, as well as Cyclothymic Disorder which does not meet criteria for mania, hypnomania or depressive episodes but still possess similar traits at a less severe level but for a period of 2 years with impaiment.

Ironically, Prolonged Grief Disorder is not associated with mood disorders in the DSM-V-TR but is a stress related disorder to acute grief which resembles depression but is a complex grief reaction.  The trajectory of normal reaction to loss is distorted due to severity of the loss, or various subjective factors involving the person.  AIHCP has numerous blogs on Complicated Grief as well as Prolonged Grief Disorder.

Treatments for Mood Disorders

Treatment for mood disorders should also include a integrated approach that includes medication as well as therapy.  Medication only masks the problem and without life skills and abilities to understand distorted thinking, then long term healing and mental health is not possible.  Also, some medications have complications which involves alternate trials and errors of different medications.  In addition, many individuals feel a mental stigma when diagnosed with depression or bipolar disorders.  This leads to hiding these feelings, or refusing to take the appropriate medications.  This leads to continued chaos, impairment, broken relationships, loss careers, and wasted time.  It is important to face mood disorders as any health condition.

SSRI help stabilize serotonin and mood

Medications

Anti-depressants are utilized to help most individuals with mood disorders, especially melancholy.    There are three types.  First, SSRIs are the most common and most used in modern medicine.  Second, tricyclic and third, monamine oxidase (MAO).  The tricyclics are rarely used with the advent of SSRI’s since tricyclics had more side effects.  SSRI’s stand for Selective Serotonin Reuptake Inhibitor.  They prevent the transfer of serotonin from one neuron to another hence preserving a higher level of serotonin to the body to help maintain mood.  MAO’s help dissolve the break down of Serotonin (Barlow, et. al., 2023).   Barlow notates that 60 to 70  percent of individuals who take medication for depression experience improvement, with half of that meeting full to close recovery to full functioning (2023).  A common SSRI’s include Prozac (fluoxetine).  Others include Celexa, Lexapro, Luvox, Paxil and Zoloft. Sometimes, individuals must go through a regiment of different SSRI until they find the best fit and dosage necessary to manage the depression.  Some need to be on SSRI longer, while others are dosed and gradually let off as needed.

Those who face treatment resistant depression can also turn to other methods to treat depression.   Holistic and natural remedies under the guidance of a primary physician such as St. John’s Wort or hypericum have shown benefits as well (Barlow, et. al., 2023).  Other more direct methods include Transcranial Magnetic Therapy (TMT) as well as Electroconvulsive Therapy (ECT) which directly sends impulses into the brain and neurons (Barlow, et al., 2023).

In regards to bi-polar disorders, a lithium based medication is utilized to help with mania.  Lithium, a common salt in  the natural environment, needs to be carefully dosed but has success with controlling mania states.  It is associated with weight gain which is another reason many individuals with bi-polar disorders wish to avoid their medication (Barlow, et. al., 2023).

Psychotherapy

Psychotherapy when supplemented with medication is the best combo for treating mood disorders.  It is important to fix the chemical issue but one also needs to have a strong understanding of self and ways to think differently.  Cognitive Behavioral Therapy plays a key role in helping individuals reframe and rethink distortions and negative connotations about self.   An individual who is depressed already has negative connotations about self, the world and the future.  AIHCP has blogs about CBT and its importance as a behaviorist therapy stemming from Aaron Beck and Albert Ellis that looks to help individuals think more healthy for better behavior and mental functioning.  In addition, human centered therapies which gravitate towards self esteem and congruence and fulfillment are important.  Karl Rogers and his person-centered therapy looks to support the client in meeting fulfillment through empathy, genuineness and unconditional positive regard.  AIHCP also has a blog to review on human-centered therapies.  Finally, interpersonal skills and support is key.  Individuals suffering from loss need support.  An individual with better support systems can overcome different losses with more success.  Some have stronger internal systems of meaning and spirituality, while others may have more family or friends or financial means to overcome loss.  Basic grief counseling in these ways can help individuals become more resilient when depressed or sad.

Conclusion

Please also review AIHCP’s Grief Counseling Program

Mood disorders can be stable with only one extreme or unstable and shift from mania to melancholy.  They are among, with anxiety, the most common psychopathologies.  Unfortunately, many individuals avoid treatment due to social stigma.  It is important to find the time to take care of one’s mental health if afflicted with a mood disorder.  Mood disorders can be genetic or causal but most all have solutions via medication, psychotherapy and counseling, or an integrated approach.

Please also review AIHCP’s Grief Counseling Certification as well as AIHCP’s multiple other behavioral health certification programs.

Additional Blogs

Anxiety Disorders:  Access here

Grief Video: Grief: The Price of Love.  Access here

Additional Resources

Bipolar Disorder. Mayo Clinic.  Access here

Clinical Depression (Major Depressive Disorder). (2026). Cleveland Clinic.  Access here

Dimaria, L. (2026).  “Types of Mood Disorders”. VeryWellMind.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic