Psychopathology, also referred to as mental disorder, is considered present when a behavior pattern or emotional state causes an individual clinically significant distress, dysfunction, or impairment in social, occupational, or other important areas of functioning or is widely deviant from social or cultural norms. This conceptual definition is somewhat subjective and might be difficult to apply in specific cases, in part because behavior patterns found to be acceptable according to the norms of one group or culture might be seen as abnormal or deviant in another. For example, self-mutilation is seen as an expression of piety in some cultures and as a sign of pathology in others.
An alternative means of defining psychopathology is to follow a more objective guide to psychiatric diagnosis in which specific symptom criteria are assessed for a standard set of mental disorders. Two related diagnostic protocols contain these specific criteria: The Diagnostic and Statistical Manual of Mental Disorders (DSM, American Psychiatric Association), and International Classification of Diseases (ICD, World Health Organization). Table 1 displays DSM criteria for the diagnosis of schizophrenia.
|Diagnostic criteria for schizophrenia|
|SOURCE: American Psychiatric Association 1994.|
|A.Characteristic symptoms (two or more)|
|d.Grossly disorganized or catatonic behavior|
|e.Negative symptoms (flat affect, avolition)|
|B.Social or occupational dysfunction in work, self-care, or social relations|
|C.The duration of the disturbance is at least six months|
|D.Symptoms not due to ingestion of medicine or drugs or due to other mental or medical disorders|
There are several broad categories of mental disorder representing differences in severity or degree of maladaptiveness. Psychotic disorders are among the most severe in that such patients are said to be out of touch with reality. For example, people suffering from schizophrenia often experience hallucinations, aberrant perceptions, such as hearing voices that others do not hear or seeing things others do not see while believing them to be actually occurring. They might also experience delusions, false beliefs, such as that they are being pursued by aliens because they hold some secret of the universe. Another defining characteristic of schizophrenia is the presence of thought disorder, in which patients are unable to maintain a coherent train of thought as their minds jump from topic to topic without apparent awareness that they are doing so.
Bipolar disorder (formerly known as manic depression) involves alternating episodes of mania in which patients are hyperactive, feel elated, and need little sleep. They might also experience delusions consistent with their mood, such as believing that they are invincible, brilliant, or have a theory that will save the world. Ultimately, they lapse into severe depression and may be unable to function at all while experiencing delusional beliefs, such as that they are dead or that their bodies are hollow.
Neurotic disorders are of a lesser degree of severity than the psychotic disorders yet cause significant distress and dysfunction to millions of people. Among the most prevalent of these are the anxiety disorders, which include the phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Mood disorders, such as major depression, are also quite common and can be episodic or continuous if not treated.
Organic mental disorders occur as a result of brain injury or disease, including dementia due to Alzheimer’s disease, head injury, Parkinson’s disease, or ingestion of toxic substances such as alcohol or inhalants. The primary areas of dysfunction in organic mental disorders include impaired abstract reasoning, lack of judgment, and impulsivity. In dementia in particular, memory deficit for new material is pronounced, and in more advanced stages entails loss of recall of previously familiar information, including recognition of family members and friends. Organic mental disorders can also involve delusions and depressive symptoms.
One in four American adults age eighteen and older has a DSM-diagnosable mental disorder within any given year. However, only one in seventeen (6 percent), suffers from serious mental disorder, such as schizophrenia or bipolar disorder. Table 2 displays prevalence figures for several of the more common mental disorders in the adult U.S. population. Approximately 20 percent of children are
|Prevalence of selected mental disorders in U.S. adults|
|Diagnostic category||Prevalence (percentage) in a given year|
|SOURCE: National Institute of Mental Health 2007.|
|Major depressive disorder||5.3|
|Post-traumatic stress disorder||3.6|
|Antisocial personality disorder||2.1|
also estimated to have a diagnosable mental disorder, but less than 9 percent are considered serious. These prevalence figures are only general averages that vary by gender, by culture and ethnicity, and from rural to urban areas. Some mental disorders found only in certain cultures are said to be culture bound, such as “running amok” in Malaysia.
Family and twin research demonstrates that there are genetic components that predispose some people to mental disorders. The closer one’s relationship to a family member with schizophrenia, for example, the more likely that person will develop the disorder. Children born of two schizophrenic parents have a 46 percent chance of developing schizophrenia at some time in their lives. Similarly, if one member of an identical twin pair becomes schizophrenic, in 48 percent of cases the co-twin will also become schizophrenic. The fact that all such identical co-twins do not become schizophrenic indicates that more than genetics is involved in developing the illness. Various environmental factors hypothesized to be involved along with the genetic predisposition in determining who becomes mentally disordered include family and life stresses, early traumatic events, and maternal illnesses at critical periods during gestation. Some anxiety, depression, and substance abuse disorders also have genetic liabilities, although the genetic contributions in most cases are not as strong as for schizophrenia and bipolar.
Psychological assessment is the process of examining a patient to understand the range of possible problems or symptoms that can then lead to a diagnosis and treatment plan. One common assessment process is administration of a mental status examination, which is a semi-structured sur-
|Mental status examination|
|Area Assessed||Sample questions or observations|
|SOURCE: University of California, San Diego, School of Medicine 2006.|
|• Orientation in time, place, and person||“Where are you? What year is it?|
|• Physical appearance||Is patient appropriately groomed and dressed?|
|• Mood and affect||“How do you feel today?”|
|•Thought processes||Is train of thought coherent, disconnected?|
|•Thought content||Does patient have delusions?|
|• Memory||Can patient recall three items after five minutes?|
|•Judgment||“What should you do if you find a lost wallet?”|
|•Abstract reasoning||“How are a peach and a banana alike?”|
|•Attention||“Count backwards from 50 by 3s”|
vey of a patient’s mental, emotional, cognitive, and behavioral functioning. Sample questions are shown in Table 3.
Personality tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), are self-administered questionnaires in which patients respond to a series of statements by indicating “true” or “false.” Examples include “I am sure that many people are out to get me” and “My head aches all over.” Patterns of responding to some 567 statements are statistically compared with patterns from samples of the normal population and of patients with various psychiatric disorders.
Brain scans represent an advance in technological assessments. X-ray and digital imaging of brain structure and function can highlight brain abnormalities associated with some mental disorders, particularly the dementias and schizophrenia.
The consequences of being mentally ill are great both for the individual and for society. For the individual, there is a strong social stigma attached to mental illness that may manifest itself in many ways, such as employment discrimination, which is greater for the mentally disabled than for the physically disabled. Fully half of employers are reluctant to hire someone with a psychiatric history or someone currently taking medication for depression.
The economic consequences for society are great as well. The World Health Organization estimates that mental illness accounts for 15 percent of the burden of disease (years lost as a result of premature death and disability) in developed countries—more than the burden caused by all types of cancers. For women, depression causes more disease burden than any other illness. In fact major depression is the leading cause of disability worldwide among individuals five years of age and older.
Numerous treatments for mental disorders have emerged, varying according to the state of medical science at any given time. When mental disorder was thought to be caused by malevolent spirits infesting the brain, treatment consisted of chipping holes in the skull (trephining) to let the evil spirits out. When overcharged blood vessels were thought to be the cause, bloodletting was prescribed to reduce pressure on the brain and to bring patients back to their senses. Although these forms of treatment are no longer used in European and North American medicine, the focus remains on the brain. Brain processes are targeted to be changed through social, psychological, or biochemical means; the bloodstream transports chemicals to the neuroreceptors in the brain to effect therapeutic emotional, behavioral, and cognitive changes.
In the late nineteenth century Sigmund Freud pioneered the use of psychological processes to effect change in mental and emotional states. His original procedures have become the subject of much debate in the fields of psychology and psychiatry, but research demonstrates that other psychological treatment procedures are quite effective in treating a number of highly prevalent mental disorders. One group of treatments, referred to as cognitive behavioral therapy, focuses on assisting patients to systematically alter their thinking processes and their behaviors in ways that effect changes in the emotions and behaviors that led to and perpetuate their dysfunction. These procedures have been particularly successful in treating anxiety disorders and depression and are as effective as medications for treating these conditions.
Psychotropic drugs are perhaps the most widely used treatments for mental disorders in the early twenty-first century. Antianxiety medications, such as the benzodiazepines (e.g., Xanax, Valium, Atavan), effectively reduce felt anxiety but have a drawback in that they are potentially addictive. These antianxiety drugs work with the GABA system of neurotransmitters, which work to inhibit nerve transmission in areas of the brain that relate to anxiety.
A widely used class of antidepressants, some of which also have antianxiety properties, are the selective serotonin reuptake inhibitors (e.g., Prozac, Zoloft, Paxil). These drugs increase the availability of the neurotransmitter serotonin in the brain and relieve depression and some anxiety.
Psychotic conditions, such as schizophrenia, are treated with several types of antipsychotic drugs (e.g., Thorazine, Haldol, Clozaril, Risperidol). These medications tend to block the neurotransmitter dopamine, which is thought to underlie schizophrenia symptoms and related psychotic states. Bipolar disorder, mania, is now treated with drugs, such as Geodon and Seroquel, that tend to reduce the hyperactive manic state and associated psychotic delusions. Although they are largely successful in reducing psychotic symptoms, prolonged use of these drugs can lead to severe movement disorders, such as Parkinsonism and tardive dyskinesia.
Psychosurgery, brain surgery to affect changes in mental or emotional states, was widely used until the advent of antipsychotic drugs in the mid-twentieth century. Since then it has been used rarely, only in cases unresponsive to standard therapies. Electroconvulsive therapy continues to be used in severe cases of depression, in which patients are unresponsive to psychotherapy or antidepressant medications. Transcranial magnetic stimulation is a promising new experimental procedure for treating severe depression and involves applying powerful electromagnets directly to the skull.
SEE ALSO Deviance; Madness; Manic Depression; Mental Illness; Neuroticism; Psychotherapy; Schizophrenia
American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: Author.
Davidson, Gerald C., John M. Neale, and Ann M. Kring. 2004. Abnormal Psychology. 9th ed. Hoboken, NJ: Wiley.
Gaw, Albert C., ed. 1993. Culture, Ethnicity, and Mental Illness. Washington, DC: American Psychiatric Press.
Gottesman, Irving I. 1991. Schizophrenia Genesis: The Origins of Madness. New York: Freeman.
National Institute of Mental Health. 2006. Publications. http://www.nimh.nih.gov/publicat.
National Institute of Mental Health. 2007. Statistics. http://www.nimh.nih.gov/healthinformation/statisticsmenu.cfm.
Ronald A. Kleinknecht
The subfield of psychology concerned with the study of abnormal behavior.
Abnormal behavior is defined as behavior that is considered to be maladaptive or deviant by the social culture in which it occurs. Though disagreement exists regarding which particular behaviors can be classified as abnormal, psychologists have defined several criteria for purposes of classification. One is that the behavior occurs infrequently and thus deviates from statistical norms. Another is that the behavior deviates from social norms of acceptable behavior. A third is that the behavior is maladaptive, that it has adverse affects on the individual or on the individual's social group. Lastly, abnormality may be defined based on the subjective feelings of misery, depression , or anxiety of an individual rather than any behavior he exhibits.
The Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV), is a classification system of abnormal behaviors which aids psychologists and other mental health professionals in diagnosing and treating mental disorders. DSM-IV includes the major categories of abnormal behavior which are anxiety disorders, such as obsessive-compulsive disorders and phobias ; affective disorders, which are disturbances of mood such as depression; schizophrenic disorders, which are characterized by major disturbances in personality and distortion of reality; and various personality disorders .
While psychologists use similar criteria to diagnose abnormal behavior, their perspectives in understanding and treating related disorders vary greatly. For instance, a psychologist with a psychoanalytic approach would explain depression as a reaction to loss, worsened by anger turned inward. A behavioral psychologist would assume a lack of positive reinforcement to be a significant cause in the disease. A cognitive theorist would focus on the negative thought patterns and attitudes of an individual in contributing to his depression. And a psychologist with a biological perspective would consider a chemical imbalance in the nervous system of a depressed individual to be responsible for his disorder. Many studies have shown that a number of these factors may come into play in the life of an individual suffering from a mental disorder characterized by abnormal behavior.
See also Mental illness; Psychotic disorders
Oldham, John M. The New Personality Self-Portrait. New York: Bantam, 1995.
Personality Disorders and the Five-Factor Model of Personality. Washington, DC: American Psychological Association, 1994.
psy·cho·pa·thol·o·gy / ˌsīkōpəˈ[unvoicedth]äləjē; -pa[unvoicedth]ˈäl-/ • n. the scientific study of mental disorders. ∎ features of people's mental health considered collectively: ageism, family discord and psychopathology all play their part in abuse. ∎ mental or behavioral disorder: she showed evidence of genuine psychopathology. DERIVATIVES: psy·cho·path·o·log·i·cal / -pa[unvoicedth]ōˈläjikəl/ adj. psy·cho·pa·thol·o·gist / -[voicedth]äləjist/ n.
1. the study of mental disorders, with the aim of explaining and describing aberrant behaviour. Compare psychiatry.
2. the symptoms, collectively, of a mental disorder.