|
A mental disorder or mental illness is a psychological or behavioral pattern generally
associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development
or culture. Such a disorder may consist of a combination of affective, behavioural, cognitive and perceptual components. The
recognition and understanding of mental health conditions have changed over time and across cultures, and there are still
variations in the definition, assessment, and classification of mental disorders, although standard guideline criteria are
widely accepted. A few mental disorders are diagnosed based on the harm to others, regardless of the subject's perception
of distress. Over a third of people in most countries report meeting criteria for the major categories at some point in their
lives. The causes are often explained in terms of a diathesis-stress model or biopsychosocial model. In biological psychiatry,
mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex
interplay of genetics and experience.[1] Services are based in psychiatric hospitals or in the community. Diagnoses are made
by psychiatrists, clinical psychologists, or psychiatric social workers[citation needed] using various methods, often relying
on observation and questioning in interviews. Treatments are provided by various mental health professionals. Psychotherapy
and psychiatric medication are two major treatment options, as are social interventions, peer support and self-help. In some
cases there may be involuntary detention and involuntary treatment where legislation allows. Stigma and discrimination add
to the suffering associated with the disorders, and have led to various social movements attempting to increase acceptance.
Disorders:
See also: List of mental disorders as defined by the DSM and ICD
There are many different categories
of mental disorder, and many different facets of human behavior and personality that can become disordered.[2][3][4][5][6]
Anxiety
or fear that interferes with normal functioning may be classified as an anxiety disorder.[7] Commonly recognized categories
include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive
disorder and post-traumatic stress disorder.
Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually
intense and sustained sadness, melancholia or despair is known as major depression or clinical depression (milder but still
prolonged depression can be diagnosed as dysthymia). Bipolar disorder (also known as manic depression) involves abnormally
"high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed mood. Whether unipolar
and bipolar mood phenomena represent distinct categories of disorder, or whether they usually mix and merge together along
a dimension or spectrum of mood, is under debate in the scientific literature.[8]
Patterns of belief, language use and perception can become disordered
(e.g. delusions, thought disorder, hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional
disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective
disorders. Schizotypy is a category used for individuals showing some of the characteristics associated with schizophrenia
but without meeting cut-off criteria.
Personality—the fundamental characteristics of a person that influence his or her thoughts
and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive.
Categorical schemes list a number of different such personality disorders, including those sometimes classed as eccentric
(e.g. paranoid, schizoid and schizotypal personality disorders), to those sometimes classed as dramatic or emotional (antisocial,
borderline, histrionic or narcissistic personality disorders) or those seen as fear-related (avoidant, dependent, or obsessive-compulsive
personality disorders). If an inability to sufficiently adjust to life circumstances begins within three months of a particular
event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an
adjustment disorder. There is an emerging consensus that so-called "personality disorders", like personality traits in general,
actually incorporate a mixture of acute dysfunctional behaviors that resolve in short periods, and maladaptive temperamental
traits that are more stable.[9] Furthermore, there are also non-categorical schemes that rate all individuals via a profile
of different dimensions of personality rather than using a cut-off from normal personality variation, for example through
schemes based on the Big Five personality traits.[10]
Eating disorders involve disproportionate concern in matters
of food and weight.[7] Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or
binge eating disorder.
Sleep disorders such as insomnia involve disruption to normal sleep patterns, or a feeling of
tiredness despite sleep appearing normal.
Sexual and gender identity disorders may be diagnosed, including dyspareunia, gender identity
disorder and ego-dystonic homosexuality. Various kinds of paraphilia are considered mental disorders (sexual arousal to objects,
situations, or individuals that are considered abnormal or harmful to the person or others).
People who are abnormally unable
to resist certain urges or impulses that could be harmful to themselves or others, may be classed as having an impulse control
disorder, including various kinds of tic disorders such as Tourette's syndrome, and disorders such as kleptomania (stealing)
or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder. Obsessive-compulsive
disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety
disorder.
The
use of drugs (legal or illegal), when it persists despite significant problems related to the use, may be defined as a mental
disorder termed substance dependence or substance abuse (a broader category than drug abuse). The DSM does not currently use
the common term drug addiction and the ICD simply talks about "harmful use". Disordered substance use may be due to a pattern
of compulsive and repetitive use of the drug that results in tolerance to its effects and withdrawal symptoms when use is
reduced or stopped.
People who suffer severe disturbances of their self-identity, memory and general awareness of
themselves and their surroundings may be classed as having a dissociative identity disorder, such as depersonalization disorder
or Dissociative Identity Disorder itself (which has also been called multiple personality disorder, or "split personality").
Other memory or cognitive disorders include amnesia or various kinds of old age dementia.
A range of developmental disorders
that initially occur in childhood may be diagnosed, for example autism spectrum disorders, oppositional defiant disorder and
conduct disorder, and attention deficit hyperactivity disorder (ADHD), which may continue into adulthood.
Conduct disorder, if continuing
into adulthood, may be diagnosed as antisocial personality disorder (dissocial personality disorder in the ICD). Popularist
labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses.
Disorders
appearing to originate in the body, but thought to be mental, are known as somatoform disorders, including somatization disorder
and conversion disorder. There are also disorders of the perception of the body, including body dysmorphic disorder. Neurasthenia
is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized
by the ICD-10 but no longer by the DSM-IV.[11]
Factitious disorders, such as Munchausen syndrome, are diagnosed where symptoms are thought to
be experienced (deliberately produced) and/or reported (feigned) for personal gain.
There are attempts to introduce a category of relational disorder,
where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between
children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis
of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship
with each other.
Various
new types of mental disorder diagnosis are occasionally proposed. Among those controversially considered by the official committees
of the diagnostic manuals include self-defeating personality disorder, sadistic personality disorder, passive-aggressive personality
disorder and premenstrual dysphoric disorder.
Two recent unique isolated proposals are solastalgia by Glenn Albrecht and hubris syndrome by
David Owen. The application of the concept of mental illness to the phenomena described by these authors has in turn been
critiqued by Seamus Mac Suibhne.[12]
Causes:
Main article: Causes of mental disorders
Mental disorders can arise from a combination of sources. In
many cases there is no single accepted or consistent cause currently established. A common belief even to this day is that
disorders result from genetic vulnerabilities exposed by environmental stressors. (see Diathesis–stress model). However,
it is clear enough from a simple statistical analysis across the whole spectrum of mental health disorders at least in western
cultures that there is a strong relationship between the various forms of severe and complex mental disorder in adulthood
and the abuse (physical, sexual or emotional) or neglect of children during the developmental years.
An eclectic or pluralistic mix
of models may be used to explain particular disorders, and the primary paradigm of contemporary mainstream Western psychiatry
is said to be the biopsychosocial (BPS) model, incorporating biological, psychological and social factors, although this may
not always be applied in practice. Biopsychiatry has tended to follow a biomedical model, focusing on "organic" or "hardware"
pathology of the brain. Psychoanalytic theories have continued to evolve alongside congitive-behavioural and systemic-family
approaches. Evolutionary psychology may be used as an overall explanatory theory, and attachment theory is another kind of
evolutionary-psychological approach sometimes applied in the context of mental disorders. A distinction is sometimes made
between a "medical model" or a "social model" of disorder and disability.
Studies have indicated that genes often play an important role
in the development of mental disorders, although the reliable identification of connections between specific genes and specific
categories of disorder has proven more difficult. Environmental events surrounding pregnancy and birth have also been implicated.
Traumatic brain injury may increase the risk of developing certain mental disorders. There have been some tentative inconsistent
links found to certain viral infections,[13] to substance misuse, and to general physical health.
Abnormal functioning of neurotransmitter
systems has been implicated, including serotonin, norepinephrine, dopamine and glutamate systems. Differences have also been
found in the size or activity of certain brain regions in some cases. Psychological mechanisms have also been implicated,
such as cognitive (e.g. reason), emotional processes, personality, temperament and coping style.
Social influences have been found
to be important, including abuse, bullying and other negative or stressful life experiences. The specific risks and pathways
to particular disorders are less clear, however. Aspects of the wider community have also been implicated, including employment
problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies
and cultures.
|
