Psychological Disorders

Chapter 14: Psychological Disorders

A Voice for People with Mental Illnesses: Elyn Saks

  • Elyn Saks is the director of the Saks Institute for Mental Health Law, Policy, and Ethics at the University of Southern California.
  • The institute focuses on informing policy decisions about mental health, aiming to help people with mental illness live fulfilling lives.
  • Initiatives include efforts to reduce workplace stigma and advocate for accommodations for individuals with mental health disabilities (Bergman, 2018).

Understanding Psychological Disorders

Key Theme

  • Understanding psychological disorders involves examining their origins, symptoms, and development, as well as their relationship to cultural and social norms.

Key Questions

  1. What defines a psychological disorder, and how do atypical behaviors differ from typical behaviors?
  2. What is DSM-5-TR, and how did it develop?
  3. How prevalent are psychological disorders?

Introduction to Psychological Disorders

  • The evaluation of behaviors as typical or atypical often depends on cultural context.
  • Encountering atypical behavior can lead to judgments that reflect common misconceptions about psychological disorders.
  • Psychopathology: The scientific study of psychological disorders, including their origins, symptoms, and development.

Typical vs. Atypical Behavior

  • The difference between normal and abnormal behavior is often a matter of degree and context rather than a strict boundary.
  • Cultural norms are crucial in defining what constitutes acceptable behavior. For example:
    • A Hindu widow adhering to dietary restrictions during mourning is engaging in typical behavior within her culture, while a widow from a different culture may not experience similar restrictions.

Social Stigma and Misconceptions

  • Stigma: Individuals with mental illness often face stigma, which varies culturally. In the U.S., stigma is notably higher in Black and Latino communities and is also prevalent in Asian cultures (DeFreitas et al., 2018).
  • Misrepresentation in media contributes to the stigma, portraying mentally ill individuals as dangerous or as helpless victims (Camp et al., 2010).

Common Myths About Violence and Mental Illness

  • It is a myth that most individuals with psychological disorders are violent; only about 4% of violent acts are committed by people with mental illness (Varshney et al., 2016).
  • Most people with mental illness are no more likely to engage in violent or illegal behavior than the general population (Peterson et al., 2014).

What Is a Psychological Disorder?

  • A psychological disorder is defined as a pattern of behavioral or psychological symptoms causing significant distress or impairment in functioning (American Psychiatric Association, 2022).
  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR): An authoritative guide for diagnosing psychological disorders, published in 2022. It includes:
    • Diagnostic guidelines and symptom descriptions for over 260 disorders and additional conditions totaling over 500 categories (Prigerson et al., 2021).

Evolution of the DSM

  • The first DSM was published in 1952, with an increase in the number of disorders included in subsequent editions. The DSM-5-TR updated the 2013 edition, adding only one new disorder: Prolonged grief disorder.
  • Some behaviors previously labeled as disorders have been removed, such as homosexuality, demonstrating evolving understanding (Frances & Widiger, 2012).

Critiques of the DSM

  • Criticisms include:
    • Use of arbitrary cutoffs for diagnoses
      disorder.
    • Symptom overlap and varied expressions leading to inconsistent diagnostics (Allsopp et al., 2019).
    • Influence of pharmaceutical sponsors affecting disorder categorizations (Cosgrove & Krimsky, 2012).

Alternative Diagnostic Approaches

  • The National Institute of Mental Health (NIMH) is exploring diagnostic models based on common biological and psychological factors rather than treating symptoms as discrete categories.
  • Research Domain Criteria (RDoC): An initiative that conceptualizes mental illness symptoms along dimensions (Conway et al., 2021).
  • Findings indicate shared genetic risk factors and other behavioral changes across various psychological disorders (Caspi et al., 2024).

The Prevalence of Psychological Disorders

  • National Comorbidity Survey Replication (NCS-R): Found that 26% of respondents experienced symptoms of a psychological disorder over the previous year; nearly 50% at some point in life (Kessler et al., 2005).
  • 2021 Data: Approximately 60 million adults in the U.S. were affected, and 1 in 8 globally face psychological disorders (WHO, 2022b).

Barriers to Treatment

  • Lack of Access: About 25% of U.S. adults with mental illness reported unmet treatment needs due to barriers such as stigma, insurance issues, and lack of awareness (SAMHSA, 2020).
  • Global Access Issues: Similar trends exist globally, indicating a fundamental challenge in mental health care (Santiago et al., 2013).

Psychological Disorders Covered

  • This chapter will focus on six categories of disorders outlined in the DSM-5-TR:
    1. Anxiety Disorders
    2. Depressive and Bipolar Disorders
    3. Eating Disorders
    4. Personality Disorders
    5. Dissociative Disorders
    6. Schizophrenia

Conclusion

  • Psychological disorders signify serious disruptions in typical experiences. While some disorders reflect a clear break from reality (like schizophrenia), others (like anxiety and depression) may illustrate a heightened degree of normal states.
  • Understanding the interconnectedness of genetic, psychological, and social factors is essential for the ongoing study of mental health issues.

Next Section

  • The next chapter will explore the treatment of psychological disorders. Additionally, this section will provide guidance on helping individuals who express suicidal thoughts or behaviors.