Psychology Chapter 13 – Psychological Disorders: Defining Mental Illness (Pages 420–427)

Abnormal Psychology & Psychopathology

• Field dedicated to the scientific study of mental disorders, covering theory, empirical research, diagnostic practice, and treatment methodology.
• Integrates multiple disciplines: biology, neuroscience, sociology, anthropology, philosophy, and clinical practice.
• Distinction from general psychology:
  • Abnormal psychology focuses on patterns that deviate from statistical, cultural, or functional norms.
  • Psychopathology zeroes in on the origin (\etiology) and progression of these disorders.
• Significance:
  • Provides the conceptual and research foundation for clinical intervention.
  • Bridges lab findings (e.g., neurotransmitter studies) with real‐world therapy.

Mental Illness – Core Definition

• Working definition (per transcript): "Health conditions involving changes in emotion, thinking, or behavior (or any combination) that are associated with distress and/or functional impairment in social, work, or family life."
• Two‐part diagnostic threshold:
  • Atypicality / Unusual behavior.
  • Maladaptiveness – the behavior must cause distress or impair functioning.
• Illustrative scenario:
  • A person who enjoys being alone (unusual) vs. a person whose social withdrawal prevents employment (maladaptive). Only the latter is clinically relevant.
• Ethical angle: Clinicians must balance respect for individual difference with the need to intervene when suffering or impairment is clear.

Prevalence Snapshot (2020)

• Approx. 21 % of U.S. adults experienced a diagnosable mental illness in 2020.
  • Expressed mathematically: 21\% = \frac{21}{100} = 0.21 of the adult population.
• Practical impact: underscores the public‐health scale of mental health care and the need for systemic resources.

Bio-Psycho-Socio-Cultural Model (BPSC)

• Multidimensional framework positing that no single factor fully explains mental illness.
• Components & examples (referenced Figure 13.1):
  • Biological: genetics, brain chemistry, hormonal influences, physical illness.
  • Psychological: cognitive patterns, emotional regulation, personality traits.
  • Social: family dynamics, peer relationships, socioeconomic status.
  • Cultural: societal norms, stigma, culturally bound syndromes, religious beliefs.
• Integrative takeaway: Treatment plans often combine medication (biological), psychotherapy (psychological), family or group interventions (social), and culturally sensitive practices (cultural).
• Hypothetical composite case:
  • Genetic predisposition + negative self‐talk + workplace bullying + cultural shame → higher depression risk.

Comorbidity

• Definition: Concurrent diagnosis of two or more psychological disorders in the same individual.
• Clinical importance:
  • Complicates treatment (e.g., substance use disorder + major depressive disorder).
  • Suggests overlapping causal mechanisms (shared genes, environmental stressors).
• Research implication: Encourages transdiagnostic approaches rather than isolated “silo” treatments.

Diagnostic Criteria & Decision Making

• Clinicians use structured criteria to determine if behavior qualifies as a disorder.
• Criteria capture:
  • Symptom count & duration (e.g., minimum 2 weeks of depressed mood).
  • Rule‐outs: medical conditions, substance effects, cultural consistency.
• Functional assessment: How much the symptoms impair daily living.
• Ethical responsibility: Prevent both false positives (over‐pathologizing) and false negatives (missing genuine distress).

The DSM (Diagnostic and Statistical Manual of Mental Disorders)

• Primary classification tool in the United States.
• Historical timeline:
  • First edition 1952.
  • Revised five times, most recent DSM-5 (2013).
• Rationale for revisions:
  • New scientific evidence (e.g., brain‐imaging, genetic findings).
  • Shifts in cultural understanding (e.g., removal of homosexuality as a disorder).
• Structure of a DSM entry:
  • Diagnostic criteria.
  • Associated features.
  • Prevalence data.
  • Development & course.
  • Risk & prognostic factors.
  • Differential diagnosis.
• Practical upside: Common language among clinicians, researchers, insurers, and patients.

Critiques of the DSM

• Categorical rigidity: Disorders are listed as discrete boxes rather than spectrums.
• Western bias: Cultural syndromes outside the West may be underrepresented or mischaracterized.
• Risk of medicalizing normal variation ("diagnostic inflation").
• Ongoing debate: Move toward dimensional models (severity scales) vs. current categorical approach.

Insurance & Health‐Care Implications

• In many systems, a formal DSM diagnosis is required for insurance reimbursement of therapy.
• Double‐edged sword:
  • Facilitates access to affordable treatment.
  • May incentivize premature labeling or stigmatization.
• Ethical consideration: Clinicians must diagnose accurately—not merely to satisfy payers.

Systematic Assessment Beyond Diagnosis

• DSM encourages evaluating:
  • Primary disorder(s).
  • Relevant medical conditions (e.g., thyroid disease mimicking depression).
  • Psychological & cultural factors (e.g., grief rituals, minority stress).
  • Overall functioning—historically via Global Assessment of Functioning (GAF), now often WHODAS.
• Holistic goal: Craft a person‐centered treatment plan that respects biological realities, psychological needs, social supports, and cultural identity.