Psychosocial Personality Disorders

Psychosocial personality disorders

Definition

A psychosocial disorder is a mental illness caused or influenced by life experiences, as well as maladjusted cognitive and behavioral processes.

Description

The term psychosocial refers to the psychological and social factors that influence mental health. Social influences such as peer pressure , parental support, cultural and religious background, socioeconomic status, and interpersonal relationships all help to shape personality and influence psychological makeup. Children and adolescents with psychosocial disorders frequently have difficulty functioning in social situations and may have problems effectively communicating with others.

In the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) , the American Psychiatric Association distinguishes 16 different subtypes (or categories) of mental illness. Although psychosocial variables arguably have some degree of influence on all subtypes of mental illness, the major categories of mental disorders thought to involve significant psychosocial factors include:

• Substance-related disorders. Disorders related to alcohol and drug use, abuse, dependence, and withdrawal.
• Schizophrenia and other psychotic disorders. These include the schizoid disorders (schizophrenia, schizophreniform, and schizoaffective disorder), delusional disorder, and psychotic disorders.
• Mood disorders. Affective disorders such as depression (major, dysthymic) and bipolar disorders.
• Anxiety disorders. Disorders in which a certain situation or place triggers excessive fear and/or anxiety symptoms (i.e., dizziness , racing heart), such as panic disorder, agoraphobia, social phobia, obsessive-compulsive disorder , post-traumatic stress disorder, and generalized anxiety disorders. Separation anxiety disorder is one permutation of anxiety disorders that is common in children.
• Somatoform disorders. Somatoform disorders involve clinically significant physical symptoms that cannot be explained by a medical condition (e.g., somatization disorder, conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder).
• Factitious disorders. Disorders in which an individual creates and complains of symptoms of a non-existent illness in order to assume the role of a patient (or sick role).
• Sexual and gender identity disorders. Disorders of sexual desire, arousal, and performance. It should be noted that the categorization of gender identity disorder as a mental illness has been a point of some contention among mental health professionals.
• Eating disorders. Anorexia and bulimia nervosa.
• Adjustment disorders . Adjustment disorders involve an excessive emotional or behavioral reaction to a stressful event.
• Personality disorders. Maladjustments of personality, including conduct, paranoid, narcissistic, avoidant, dependent, and obsessive-compulsive personality disorder (not to be confused with the anxiety disorder OCD).
• Disorders usually first diagnosed in infancy, childhood, or adolescence . Some learning and developmental disorders (i.e., ADHD) may be partially psychosocial in nature.

Demographics

According to the National Institute of Mental Health, an estimated one in 10 children and adolescents in the United States suffers from mental illness severe enough to cause significant impairment in their day-today living. The MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) put the number even higher, estimating that nearly 21 percent of U.S. children between the ages of nine and 17 had a diagnosable mental disorder associated with at least minimum impairment.

Causes and symptoms

It is important to note that the causes of mental illness are diverse and not completely understood. The majority of psychological disorders are thought to be caused by a complex combination of biological, genetic (hereditary), familial, and social factors or biopsychosocial influences. In addition, the role that each of these plays can differ from person to person, so that a disorder such as depression that is caused by genetic factors in one person may be caused by a traumatic life event in another.

The symptoms of psychosocial disorders vary depending on the diagnosis in question. In addition to disorder-specific symptoms, children with psychosocial dysfunction usually have difficulty functioning normally in social situations and may have trouble forming and maintaining close interpersonal relationships.

When to call the doctor

Any child or adolescent that exhibits symptoms of psychosocial personality disorder should be taken to his or her health care provider as soon as possible for evaluation and possible referral to a mental health care professional. If a child or teen reveals at any time that he or she has had recent thoughts of self-injury or suicide , or if he or she demonstrates behavior that compromises personal safety or the safety of others, professional assistance from a mental health care provider or care facility should be sought immediately.

Diagnosis

Children with symptoms of psychosocial disorders or other mental illness should undergo a thorough physical examination and patient history to rule out an organic cause for the illness (such as a neurological disorder). If no organic cause is suspected, a psychologist or other mental healthcare professional will meet with the child and her parents or guardians to conduct an interview and take a detailed social and medical history. Interviews with caretakers and teachers may also be part of the diagnostic process.

The child and/or the child's parents may be asked to complete one or more psychological questionnaires or tests (also called clinical inventories, scales, or assessments). These may include the Children's Depression Inventory (CDI), the Diagnostic Interview Schedule for Children (DISC), Youth Self-Report, the School Social Behavior Scales (SSBS), the Overt Aggression Scale (OAS), Behavioral Assessment System for Children (BASC), Child Behavior Checklist (CBCL), the Nisonger Child Behavior Rating Form (N-CBRF), Clinical Global Impressions scale (CGI), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and the Millon Adolescent Personality Inventory (MAPI).

Treatment

Counseling is typically a front-line treatment for psychosocial disorders. A number of counseling or talk therapy approaches exist, including psychotherapy, cognitive therapy, behavioral therapy, and group therapy. Family therapy may be recommended to help parents and siblings understand and cope with a child's mental illness. Therapy or counseling may be administered by social workers, nurses, licensed counselors and therapists, psychologists, or psychiatrists.

Psychotropic medication may also be prescribed for symptom relief in patients with mental disorders considered psychosocial in nature. For disorders such as major depression or bipolar disorder , which may have psychosocial aspects but also have known organic causes, drug therapy is a primary treatment approach. In cases such as personality disorder that are thought to not have biological roots, psychoactive medications are usually considered a secondary, or companion treatment to psychotherapy. It is important to note that there is limited data on the long-term repercussions of the use of most psychotropic medications in children and teens; the prescribing physician should present parents with an analysis of the risks and benefits of drug therapy before a course of treatment begins.

In some cases, treating mental illness requires hospitalization . This hospitalization, also known as inpatient treatment, is usually employed in situations where a controlled therapeutic environment is critical for the patient's recovery (e.g., rehabilitation treatment for alcoholism or other drug addictions), or when there is a risk that the patient may harm himself (suicide) or others. It may also be necessary when the patient's physical health has deteriorated to a point where life-sustaining treatment is necessary, such as with severe malnutrition associated with anorexia nervosa .

Adolescents may be successful in treating psychosocial disorders through regular attendance in self-help groups or 12-step programs such as Alcoholics Anonymous. This approach, which allows them to seek advice and counsel from others in similar circumstances, can be extremely effective.

Alternative treatment

Therapeutic approaches, such as art therapy, which encourages self-discovery and empowerment, may be useful in treating psychosocial disorders. Art therapy, the use of the creative process to express and understand emotion, encompasses a broad range of humanistic disciplines, including visual arts, dance, drama, music, film, writing, literature, and other artistic genres. This use of the creative process is believed to provide the patient/artist with a means to gain insight to emotions and thoughts they might otherwise have difficulty expressing. After the artwork is created, the patient/artist continues the therapeutic journey by interpreting its meaning under the guidance of a trained therapist.

Prognosis

According to the National Institute of Mental Health, fewer than one in five of those children suffering from mental illness receive treatment for the problem. Because of the diversity of types of mental disorders influenced by psychosocial factors, and the complexity of diagnosis and treatment, the prognosis for psychosocial disorders is highly variable. In some cases, they can be effectively managed with therapy and/or medication. In others, mental illness can cause long-term disability.

KEY TERMS

Affective disorder —An emotional disorder involving abnormal highs and/or lows in mood. Now termed mood disorder.

Bipolar disorder —A severe mental illness, also known as manic depression, in which a person has extreme mood swings, ranging from a highly excited state, sometimes with a false sense of well being, to depression.

Bulimia nervosa —An eating disorder characterized by binge eating and inappropriate compensatory behavior, such as vomiting, misusing laxatives, or excessive exercise.

Cognitive processes —Thought processes (i.e., reasoning, perception, judgment, memory).

Learning disorders —Academic difficulties experienced by children and adults of average to above-average intelligence that involve reading, writing, and/or mathematics, and which significantly interfere with academic achievement or daily living.

Schizophrenia —A severe mental illness in which a person has difficulty distinguishing what is real from what is not real. It is often characterized by hallucinations, delusions, and withdrawal from people and social activities.

The U.S. Centers for Disease Control reports that suicide is the third leading cause of death among children and youth between the ages of 10 and 24. Because more than 90 percent of those who commit suicide have a diagnosable mental disorder, seeking swift and appropriate treatment as soon as symptoms appear is critical

Prevention

Patient education (i.e., therapy or self-help groups) can encourage patients to take an active part in their treatment program and to recognize symptoms of a relapse of their condition. In addition, educating friends and family members on the nature of the psychosocial disorder can assist them in knowing how and when to provide support to the patient.

Parental concerns

While seeking help for their child, parents must remain sensitive to the emotional needs and physical well being of their other children. This may mean adjusting regular routines to avoid leaving siblings alone together, getting assistance with childcare, or even seeking residential or hospital treatment for the child if the safety of other family members is in question. Parents should also maintain an open dialog with their child's teachers to ensure that their child receives appropriate educational assistance.

See also Anorexia nervosa; Bipolar disorder; Depressive disorders.

Resources

BOOKS

Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Press, Inc., 2000.

PERIODICALS

Satcher, David. Mental Health: A Report of the Surgeon General. Washington, DC: Government Printing Office, 1999.

Sullivan, Michele G. "Look for risk factors, protective factors in suicide attempters: psychiatric illness is strong risk factor." Family Practice News. 34, no. 4 (Feb 14, 2004): 62.

ORGANIZATIONS

The American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Ave., N.W., Washington, D.C. 20016–3007. (202) 966–7300. Web site: <www.aacap.org>.

National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892–9663. (301) 443–4513.

WEB SITES

The National Mental Health Association. <www.nmha.org/>.

NYU Child Study Center. Changing the Face of Child Mental Health <www.aboutourkids.org/>.

Paula Ford-Martin