Author: Mark Moran

The DSM-V-TR and Disruptive, Impulse Control and Conduct Disorders

Posted on by Mark Moran

Emotional loss of control that translates into disruptions, conduct violations against social norms and laws, and the rights of others are the product of a variety of deeper seeding issues stemming in childhood.  While many of these disruptive, impulse control and conduct disorders manifest in early childhood, if left unchecked, they can continue to develop into early adulthood and root into a person’s personality.  In fact, conduct disorder itself, can be a precursor to anti-social disorder (DSM-V-TR, 2022).  With this in mind, it is important to teach, guide and when necessary reprimand children in accordance with morality, authority and law.  This is especially true for individuals who genetically have a predisposition to  impulse control, emotional outbreaks and defiance.

Disruptive, impulse control and conduct disorders develop during childhood but can cause impairment in adulthood. Please also review AIHCP’s Behavioral Health Certifications as well as its Anger Management Courses

Please also review AIHCP’s behavioral health certifications, including Anger Management Courses, as well as ADHD Consulting.

Types of Disorders

These types of disorders include issues with emotional control but especially when it infringes upon the rights of others.

Oppositional Defiant Disorder

This disorder tends to manifest early in childhood but can continue to persist in adulthood and hamper a person’s future relationships as well as one’s interaction with authority figures.  The DSM-V-TR points out that it is marked with a pattern of an overall angry and irritable mood that displays itself in an argumentative, defiant way, characterizing vindictiveness.  This mood persists for at least 6 months (DSM-V-TR, 2022).  It is important to evaluate this time frame because child development can sometimes mimic these behaviors short term and not necessarily constitute a long term disorder.  During this 6 month period, the individual must exhibit four of the below symptoms with at least one person who is not a sibling.

1.losing temper

2. touch or easily annoyed

3. often angry or resentful

4. often argues with authority figure

5. defies or refuses to comply with requests from an authority figure

6. deliberately annoys others

7. blames other for his or her mistakes or behaviors

8. exhibited spitefulness or vindictive behavior twice within the last 6 months

These symptoms can be specified as mild, moderate or severe (DSM. V-TR, 2022).

Intermittent Explosive Disorder

Loss of control and temporary rage can sometimes be more than a mere temper, loss of patience, or anger issue but can also be an emotional disorder that requires deeper care and therapy.  Intermittent Explosive Disorder emerges in childhood but can also persist into adulthood and cause serious relationship issues in all aspects of life and especially result in criminal charges.  The DSM-V-TR cites that IED exhibits frequent and recurrent outbursts due to a failure to control aggressive impulses (2022).  These outbursts can result in verbal aggression including temper tantrums, tirades, verbal arguments or even physical aggression towards property, animals or other people.  The outbursts can be limited to only verbal but also to physical confrontations that cause damage and injury.  The DSM-V-TR states that 3 serious infractions must occur within a 12 month period that result in damage or destruction, but frequent verbal aggression according to the first standard meets the first criteria.

Intermittent Explosive Disorder deals with sudden anger bursts that are not proportionate to the event

In addition to verbal or physical outbursts, the magnitude of the aggressiveness must not be proportionate with the provocation or to any of the causing stressors.  Individuals with IED react completely out of proportion to life events and daily stresses that others would not react to (DSM-V-TR, 2022).   In addition, these outbursts are not premeditated or meant to achieve some objective but are purely reactive.  In addition, these recurrent aggressions and outbursts cause considerable impairment to the person’s personal, professional, and interpersonal functioning.  Finally, the person must be at least 6 years of age.  This disorder manifests at a higher level in males and exist in both children and adults if left untreated (DSM-V-TR, 2022).  Please also review AIHCP’s Anger Management Consulting Certification.

Conduct Disorder

Conduct Disorder is a repetitive and persistent pattern of behavior which violates the rights of others, social norms and rules and laws of societal norms (DSM-V-TR, 2022). If 3 of the following 15 criteria is met over the past 12 months, with one having to be within 6 months, then an individual may be diagnosed with Conduct Disorder.  The categories of disorder include aggression, destruction of property, deceitfulness and theft, and serious violation of rules.

  1. Often bullies
  2. initiates physical fights
  3. uses weapons to cause harm
  4. cruel to other people
  5. cruel to animals
  6. stolen while confronting a victim
  7. fire setting
  8. destroying other’s property
  9. broken into another’s home
  10. lies to obtain goods or favors
  11. has committed non-violent theft
  12. defies curfews before age 13
  13. ran away from home at least twice
  14. truant from school

The DSM-V-TR points out that these acts constitute great inter-social impairment and have occurred before 18.  If over 18, the individual can qualify for diagnosis of Anti-Social Personality Disorder (2022).   Specifiers include childhood onset and adolescent onset.  In addition, specification can include with limited prosocial emotions, lack of remorse or guilt, callous or lack of empathy, unconcerned about performance, and shallow deficient affect (DSM-V-TR, 2022).   The condition can finally also be classified as mild, moderate or severe.

Within Conduct Disorder as well as Anti-Social Disorder, two other types of disorders can manifest.

Pyromania

This disorder leads to the deliberate and purposeful choice to set fires on more than one occasion.   The DSM-V-TR differentiates the setting of fire for reason or gain to that correlated with an affective arousal before the act that includes a fascination or interest about the attraction to fire.  Pleasure, gratification or relief is associated with setting the fire (2022).

Kleptomania

Like fire setting, the act of stealing in Kleptomania is not tied to gain or need but a recurrent failure to resist the impulse to steal due to the sense of tension to commit theft.   From this theft, comes gratification and relief that is not associated with any motive or need (DSM-V-TR, 2022).

The Role of ADHD in Many Disruptive, Impulse Control and Conduct Disorders

ADHD is not listed with these types of disorders in the DSM-V-TR but is listed under neurodevelopmental disorders, but it does cross lines with many impulse disorders and is commonly comorbid with those who also possess them (DSM-V-TR, 2022. Obviously man individuals with ADHD are not criminals, or have rage, but symptoms of ADHD can contribute to the inner turmoil of those.  This may have something to do with the lack of control of impulses and constant inability to maintain focus on one thing.

ADHD effects both attention and hyperactivity. Although diagnosed before 12, it does exist in adulthood. Please review AIHCP’s ADHD Consulting Program

For purposes of analysis, the DSM-V-TR states that ADHD causes persistent lack of ability to focus attention and/or possess hyperactivity or impulsiveness in behavior.  Some may exhibit only inattentiveness, while others may just display hyperactivity, while some may be burdened with both sets of symptoms.  These symptoms emerge before age 12 and can persist into adulthood.  Some elements of it are later controlled by a more developed brain in adulthood and manifest in other ways.  Inattentive symptoms include at least 6 of the following over a 12 month span

  1. failure to give attention to details resulting in careless mistakes
  2. difficulty sustaining attention
  3. does not seem to listen to instruction
  4. does not follow through on instructions
  5. difficulty organizing tasks
  6. reluctant to engage in tasks involving concentration
  7. loses things
  8. easily distracted by external stimuli
  9. often forgetful

Hyperactive symptoms must include 6 of the following over a 12 month period

  1. fidgets physically
  2. cannot remain seated
  3. runs, moves, climbs on things
  4. cannot engage in leisure activities
  5. unable to relax
  6. talks excessively
  7. blurts out answers without impulse
  8. difficulty waiting turns
  9. interrupts and intrudes

Again, according to the DSM-V-TR, these symptoms can be predominantly inattentive or hyperactive or consist of both symptoms.   It can also be classified as mild, moderate or severe (DSM-V-TR, 2022). It is no wonder then that many of these issues also correlate with various disruptive, impulse control and conduct disorders or later can possible develop into it.  Please also review AIHCP’s ADHD Consulting Program.

Etiology and Treatment of Disruptive, Impulse Control and Conduct Disorders

Many of these disorders include both nature and nurture.  ADHD exists at a level of 4 to 5 percent worldwide within children (Barlow, et al., 2023).  Genetically, individuals can be prone to higher risk taking within the brain that inhibits fear or punishment (Barlow, et al,.2023).  Biologically, levels of serotonin and epinephrine can be low with higher levels of testosterone (McRay, et al, 2016),.  In addition, lack of family discipline, family dysfunction, divorce, and lack of family involvement can lead to deeper seeded issues that manifest in the child’s behavior and if not treated later manifest in adulthood (McRay, et al., 2016).

Treatment for conduct and impulse control issues include behavioral strategies that try to correct the operant conditioning previously experienced in life.  Others include training for parents to better manage the child and teach the child structure.  Also important, includes various forms of CBT that look to help empower the child  with better social cognition skills and problem solving strategies.  For anger issues, sometimes peer groups can help.  Anger Management skills can help many find solutions to their temper.  Finally, stimulant medication can be beneficial due to these disorders high comorbidity with ADHD (McRay, et al., 2016).

Conclusion

Self control is important but is harder for those with impulse and disruptive disorders. Please also review AIHCP’s Healthcare Certification Programs

Ultimately, disorders are not justifications for poor behaviors but they are explanations why some children, and even adults, are more inclined to react and behave certain ways.  Merely because someone feels an urge or a stronger intense feeling to do wrong or be cruel is never a justification but with therapy and sometimes medication, individuals can be taught to better control and maintain disruptive and impulse control behaviors.

A strong moral conviction of right and wrong is always a powerful deterrent in life.  Understanding within one’s conscience that a feeling or urge does not justify a certain behavior is the first step to finding the help one needs.  Obviously at an earlier age, parental guidance and discipline is essential to prevent these disorders from completely transforming an individuals personality into habitual chaos.  Anger, lack of impulse control, defiance of authority and rage lead to many crimes and broken lives.  It is hence important to maintain control in these situations and if one cannot to find the necessary guidance and help to learn how to control one’s inner disorders.

Please also review AIHCP’s Behavioral Health Certifications as well as AIHCP’s Anger Management Consulting Certification as well as its ADHD Consulting Program

Additional Blogs

Intermittent Explosive Disorder.  Access here

ADHD.  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

“What are Disruptive, Impulse Control and Conduct Disorders?” APA.  Access here

IED.  Mayo Clinic.  Access here

ODD. (2026). Cleveland Clinic.  Access here

“Oppositional Defiant Disorder”. Psychology Today.  Access here

Bhandari, MD, (2024). “Mental Health and Conduct Disorder”. WebMD.  Access here

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