Mental Health Glossary

Clarifying Psychological Terms

Mental Health Terminology

Diagnostic & Statistical Manual of Mental Disorders (DSM): The DSM-V-TR is the diagnostic manual used by mental health professionals to classify, research, and diagnose mental disorders. The DSM is published by the American Psychiatric Association (APA) and, as of 2022, in its sixth edition (DSM-V-TR). The original DSM was published in 1952 by the AMA.

History and Evolution of the DSM:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) dates back to the 1840s and was originally developed in service of reporting statistics to the United States Bureau of the Census when they first attempted to count the number of patients who were - confined - living in mental hospitals.

In 1849, Isaac Ray, a superintendent of the Butler Hospital in Rhode Island, called for a uniform system of naming, classifying, and recording cases of mental illness at The American Institutions for the Insane annual conference. In 1913, Dr. James May made the same plea at the organization’s annual meeting, which fortunately (Thank God) had been re-named, The American Medico-Psychological Association.

In 1933, the first manual was titled Statistical Manual for Mental Diseases by the New York Academy of Medicine, and the organization above, The American Medico-Psychological Association, which later, finally became The American Psychiatric Association.

The DSM-I, the first edition of the Diagnostic and Statistical Manual of Mental Disorders, was published in 1952. It maintained the coding system of earlier manuals, and many of the disorders were termed "reactions," a term borrowed from a German psychiatrist.

The DSM-II, published in 1968, was largely a repetition of DSM-I and the first attempt to coordinate the American DSM with the World Health Organization's International Classification of Diseases (ICD).

DSM-III, published in 1980, represented a major break from the first two editions. It introduced a descriptive symptom-based approach to mental disorders, added lists of explicit diagnostic criteria, removed references to the etiology of disorders, and established the present multi-axial system of symptom evaluation. A group of psychiatrists initiated this change at Washington University in St. Louis to improve the state of research in American psychiatry.

DSM-III-R was published in 1987 and made further revisions to the diagnostic criteria and classification system.

DSM-IV was published in 1994 and made further refinements to the diagnostic criteria and the introduction of new disorders such as Asperger's Syndrome.

DSM-IV-TR (TR = text revision) was published in 2000. The diagnoses remained essentially the same; there were minimal changes to the course, prevalence, & some research updates from DSM-IV to DSM-IV-TR, but primarily the text revision was published to coordinate DSM codes with the current ICD-9 codes.

DSM-5 was published in 2013 and made significant changes to the diagnostic criteria, including the removal of certain disorders, such as Asperger's Syndrome, and the inclusion of new conditions, such as Disruptive Mood Dysregulation Disorder. It also introduced a dimensional approach to assessment, allowing for the recognition of the complexity and variability of mental disorders.

DSM-V-TR was published in 2022 and is the current manual in use today.

The DSM is widely used by mental health professionals, including psychiatrists, psychologists, and other therapists, to diagnose and treat mental disorders. Insurance companies and government organizations also use it to determine reimbursement and benefits for mental health treatment.

However, it is important to note that the DSM is not without its critics. Some argue that it is based on subjective criteria and does not take into account the social and cultural factors that may contribute to the development of mental disorders. Others point out that the manual does not consider the underlying causes of mental disorders and that the diagnostic categories are not always clearly defined. Additionally, some experts have raised concerns about the potential for overdiagnosis and over-medication due to the use of the DSM. Despite these criticisms, the DSM remains the most widely-used diagnostic manual in the field of mental health in the United States.

DSM-IV, which was published in 1994, made further refinements to the diagnostic criteria, as well as the introduction of new disorders such as Asperger's Syndrome. It also introduced the concept of "subthreshold" disorders, which are conditions that do not meet the full criteria for a disorder but still cause significant distress or impairment. Additionally, it introduced the concept of "not otherwise specified" (NOS) categories, which allow for the diagnosis of conditions that do not fit into any of the other diagnostic categories.

One of the significant changes in DSM-IV was the inclusion of dimensional assessments for personality disorders rather than the categorical approach used in previous editions. This change was intended to reflect the fact that personality disorders are often not clear-cut, and that individuals may have features of more than one disorder.

DSM-IV also introduced a multiaxial system of diagnosis that includes five axes: Axis I includes the major diagnostic categories, such as mood disorders and schizophrenia. Axis II includes personality disorders and mental retardation. Axis III includes general medical conditions that may be relevant to the individual's mental disorder. Axis IV includes psychosocial and environmental problems. Axis V includes the Global Assessment of Functioning (GAF) score, which is a numerical rating of an individual's overall level of functioning.

Original Purpose of the DSM: The DSM was intended to create a standardized language and a nomenclature for statistical recording by clinicians and researchers. The DSM was for record-keeping, tracking, short-hand clinical communications, and research; it was not intended to be utilized in the manner we utilize it today or for insurance reimbursement. Furthermore, it is helpful to understand that the original DSM conceptualized diagnoses more on a continuum awareness that, to some degree, mental suffering reactions to complex changes in one’s environment, loss, or reality are to be expected. A wide range of reactive adaptations (symptoms) to the environment exist.

Over time, the general descriptions of environmental reactions or maladaptations shifted to a more medical model, with a specific criterion style that emerged in the third version; the DSM-III shifted dramatically from the descriptions and terminology of DSM-I and DSM-II to precise diagnostic disorder criteria.

Anxiety Disorders: Within the DSM-V-TR, there are several different anxiety disorders. They are characterized by excessive, persistent worry and fear. Usually, they include compensatory avoidance behavior(s) intended to assuage anxious feelings (the avoidance behavior alleviates short-term anxiety, but over time, the avoidance increases anxiety). Anxiety disorders include Generalized Anxiety Disorder (GAD), Panic Disorder, Phobias, and Social Anxiety Disorder. Note that PTSD was formerly categorized as an anxiety disorder but was removed from the anxiety disorder classification in the DSM-V.

• Generalized Anxiety Disorder (GAD): is characterized by excessive worry about several things consistently and a persistent pattern of engagement with objects, people, and the environment.

• Panic Disorder: is characterized by recurrent and unexpected panic attacks, which often come on seemingly unprovoked and out of the blue. A panic attack is a sudden sensation of intense waves of intense fear and is very uncomfortable; that includes physical symptoms. The symptoms can include rapid heartbeat, sweating, stomach cramping, nausea, a sudden upset of gastrointestinal/diarrhea, shaking, thoughts/fears of dying, not being OK, or having a heart attack.

• Social Anxiety Disorder: a social phobia is a fear of being negatively evaluated or rejected, characterized by intense anxiety and self-consciousness, and avoidance of social situations. Dr. Marcia Linehan, the creator of evidence-based mindfulness psychotherapy, Dialectical Behavior Therapy (DBT), explains that for the socially phobic person, the point of awareness of the self is outside the self; the primary perception of me is not from within me. Instead, the social phobic perceives herself from outside herself, as she perceives & imagines others are looking at her. This stance and point of self-perception and relationship is the predominant mechanism generating and encouraging a “neurotic” or distorted response to social interactions or Social Phobia.

Depression or Depressive Disorders: are classified as Mood Disorders in the DSM. Depression is a mental condition that frequently includes overwhelming feelings of sadness. However, depression presents differently for different people. For some, it may include forgetting to shower or eat and not caring about maintaining home or hygiene, almost a nihilistic element. For another, it may look like lethargy, weight gain, and hypersomnia. For still others, it may present as restlessness or irritability (anger presentation is common in adolescent boys and men) and negative self-talk. Feelings of loss and sadness frequently characterize depression, crying spells, a lack of interest in activities that one used to find enjoyable, and hopelessness about the future. In more severe cases, depression can include thoughts of harming oneself, suicidal ideation, or thinking that others would be better off or that it would be easier if they were not here. These symptoms and presentations of depression range in severity from mild to severe and how much they interfere with daily functioning.

Bipolar I Disorder: A mental disorder characterized by extreme mood swings from very low states of heavy, dark depressive episodes to very high energetic states called manic episodes. The mania portion of this disorder is usually the part that people have a hard time letting go of, as the positives here can be quite expansive and euphoric experiences of high energy, possibility, and power. However, they include high-risk, dangerous behavior, hypersexuality, overspending, insomnia, fast-firing ideas, highly agitated, irritability, pressured speech, little need for sleep, psychosis, and delusion.

Major Depressive Disorder (MDD): MDD, also known as clinical depression, is characterized by persistent feelings of sadness, loss of interest or pleasure, and a range of other symptoms, such as changes in appetite or sleep patterns, fatigue, difficulty concentrating, and thoughts of suicide or self-harm.

Persistent Depressive Disorder (PDD): PDD, also known as dysthymia (in prior DSM’s, the diagnosis was Dysthymic Disorder), is characterized by a chronic low mood lasting at least two years. Symptoms are similar to those of MDD but are less severe and debilitating than those which encompass a major depressive episode.

Bipolar Related Disorders: Bipolar disorder, discussed more fully above, is characterized by episodes of mania or hypomania, which alternate with episodes of depression. There are different types of bipolar disorder, including Bipolar I Disorder (a more severe condition that usually necessitates mood stabilizer medications), Bipolar II Disorder (less severe, hypomania instead of full-blown mania), Cyclothymic Disorder, and Bipolar NOS.

Bipolar disorder not otherwise specified (NOS): is a psychiatric term used to describe an individual with some but not quite all of the symptoms of one of the diagnostic categories for bipolar disorder. This diagnosis ended with the DSM-IV. The DSM-V replaced “Bipolar NOS” with the diagnosis “Unspecified bipolar and related disorder.”

Disruptive Mood Dysregulation Disorder (DMDD): DMDD is primarily diagnosed in children. This childhood disorder is characterized by severe and recurrent temper outbursts that are out of proportion to the situation and by persistent irritability or anger between outbursts.

Premenstrual Dysphoric Disorder (PMDD): PMDD is a severe form of premenstrual syndrome (PMS) characterized by a range of symptoms, such as mood swings, depression, anxiety, irritability, and physical symptoms, that occur in the week or two before menstruation. PMDD is often treated with SSRI medications.

Substance/Medication-Induced Mood Disorder: This category includes mood disorders caused by the use of substances, such as drugs or alcohol, or by the use of medications. The mood disorder cannot be present without the use or withdrawal effects of a substance.

Mood Disorder Due to Another Medical Condition: This category includes mood disorders caused by a medical condition, such as a brain injury, thyroid disorder, or cancer.

Schizophrenia: A chronic and serious mental disorder affecting one’s perception of reality, characterized by “negative symptoms and positive symptoms.” The positive symptoms include psychosis forms like delusions and hallucinations. Hallucinations include seeing, feeling, tasting, hearing, or smelling things others do not see, feel, taste, touch, or smell. Some may term this a disconnection from reality, and others explain the experience of psychosis as a non-normative perception of reality and compare psychosis to those forms often experienced with psychedelics. Delusions are beliefs that friends or family might find strange/not believe, such as delusions of grandeur (I am Jesus) or paranoid delusions (The government is tracking me and sending messages to me through this magazine), and whether or not these delusions are bizarre or non-bizarre delusions. Schizophrenia also includes “negative symptoms” such as flat or blunted affect, depression symptoms, lack of speech, volition, or an absence of behavior.

Obsessive-Compulsive Disorder (OCD): A mental disorder characterized by unwanted and recurring thoughts (obsessions) and repetitive behaviors (compulsions) that a person feels compelled to perform in response to the obsession to quell the anxiety surrounding their obsession. They follow a directive order to do XYZ to relieve the worry. For example, the person has the anxiety-producing thought that if they do not re-fold all of their clothes perfectly and neatly, just right in their drawers, they will not make the dance team. So the person - having awareness at the same time that this is highly unlikely, does the compensatory ordered behavior “just in case.” Over time, this forms a pattern of OCD wherein one becomes worried about worrying, worried about their thoughts, and increasingly scanning for possible threats. Unable to stop thinking, a cat-and-mouse game of avoidance of one’s mind ensues, compounded by the compensatory compulsive practice of trying to compensate for every threat thought that appears, one can go deep down the rabbit hole of OCD thought-behavior looping. This creates a considerable amount of baseline daily anxiety and discomfort.

Post-Traumatic Stress Disorder (PTSD): A mental disorder that can develop after a person experiences or witnesses a traumatic event, such as combat, sexual assault, or a natural disaster. PTSD includes re-experiencing symptoms, avoidance symptoms, sometimes dissociative symptoms, and affective differences.

Eating Disorders: A group of mental disorders characterized by abnormal eating behaviors, relationships, and attitudes toward food, control, boundaries, and the body. Examples include Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.

Personality Disorders: A group of mental disorders characterized by long-standing patterns of thinking, feeling, and behavior structures that often create problems in their relationships with other people. The patterns of interaction deviate from cultural and social norms. Personality Disorders are categorized into Clusters A, B, and C.

Cluster B examples include Borderline Personality Disorder and Narcissistic Personality Disorder.

Attention-Deficit Disorder (ADD): A neurodevelopmental disorder characterized by difficulty with attention, hyperactivity & impulsivity. Types of ADD include the hyperactive type (most commonly diagnosed in children), the inattentive type, and the mixed type. The hyperactive type of ADD is quick to action and may get in trouble at school because they have difficulty inhibiting their impulses. They often interrupt people or blurt out answers in class instead of waiting for their turn or raising their hands. Those with the inattentive type of ADD have difficulty paying attention in the moment to place, time, space, and important details. They are frequently late, misplace items regularly like their shoes or car keys, or they forget to pay a bill; ADD inattentive type is the most common type diagnosed in adults. The mixed type is a combination of both impulsive hyperactivity and inattention.

Autism Spectrum Disorder (ASD): A neurodevelopmental disorder, better stated as neuro-atypcial, non-neurotypical (vs. the normative, neurotypcial processing person), characterized by difficulty with social interaction. They often have trouble relating and connecting with other people, miss social cues, fail to engage in normative, reciprocal pro-social communication and eye contact, and may be uncomfortable with physical touch. They are seemingly singularly focused on something and have challenges with transition/change. They engage in and are soothed by routine and repetitive behaviors.

Aspergers Syndrome: In former DSM editions, before 2013, the diagnosis of Aspergers was introduced briefly; Asperger’s was essentially a higher-functioning diagnosis within the Autism Spectrum. Social interactions challenge people with high-functioning autism or Asperger's. These individuals struggle to perceive and comprehend others’ perspectives and emotions accurately. Regardless of this deficit, someone with Aspergers or higher-functioning Autism Spectrum Disorder usually has intact cognitive and language capacities, which are neurotypical. This diagnosis is no longer in the DSM, rather has been absorbed into the spectrum model.

Wise Mind is a mindfulness concept from mindfulness-based psychotherapy, Dialectical Behavioral Therapy (DBT), created by psychologist, behavioral researcher, & Zen practitioner Dr. Marcia Linehan. A wise Mind is a state of being grounded, centered, and deeply connected within. It is a state of peace, clarity, and wisdom. The Wise Mind is a state of being, moving, & knowing directed from within. When connected with our Wise Mind, we spontaneously act wisely. Some understand Wise Mind consciousness as our natural state, our divine nature. Others call the Wise Mind their true self, the higher self, the inner physician, the seat of the soul, or inner divinity. The important thing to understand about the Wise Mind is that everyone has one. Everyone. Many of us may lose contact with our Wise Minds, and some may come to believe over years of conditioning that they truly do not have inner intelligence. However, the Wise Mind does not abandon us, she may be covered up with piles of dirty laundry, but she remains seated within you, and within me, the Wise Mind is within all everyone.

The Wise Mind concept is taught at the very beginning of DBT skills training, in conjunction with two other states of mind, the Emotion Mind and Rational Mind; the Wise Mind is described as both a middle ground and a combination of the emotional mind (information from our emotional mind is typically hot, intense, insistent, or urgent) and rational mind (data from the rational mind is typically logical, analytical, mathematical, scientific date), and in true dialectical fashion, the Wise Mind is both from and also far greater & deeper than both data sources. “The task for all of us is to connect from our own inner wisdom and then act from there.” Marcia Linehan, PhD

Archetypes: are patterns and structures that are universally experienced. Archetypal energies and types constellate within all human beings, timelessly, throughout the ages, facing parallel challenges, feelings, behaviors, and conflicts played out across all men's lives. Archetypal themes can be found in our fairy tales, myths, stories, and the beliefs of all cultures and religions throughout history. They are thought to be deeply ingrained in the human psyche and are believed to represent fundamental human experiences and emotions. Carl Jung developed the concept of archetypes, which he believed to be innate and universal patterns of behavior and personality that reside in the collective unconscious and shape our understanding and interactions with others, and ourselves, and color how we see our place in the world.

Archetypal Psychology: James Hillman furthered the depth of psychological work Carl Jung began with archetypes. Hillman trained at the C.G. Institute in Zurich, but he and others ultimately broke off from the Jungian school of thought and moved away from psychoanalytic psychology and created Archetypal Psychology, which relies heavily on the imaginal realm and criticizes other schools of psychology as being reductionistic (cognitive school) and devoid of psyche. Archetypal psychology believes that psyche is known only through metaphor and imagination.