Psychopathology

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Psychopathology is the scientific study of mental disorders, including efforts to understand their genetic, biological, psychological, and social causes; develop classification schemes (nosology) which can improve treatment planning and treatment outcomes; understand the course of psychiatric illnesses across all stages of development; more fully understand the manifestations of mental disorders;[a] and investigate potentially effective treatments.[b][1]

At least conceptually,[c] psychopathology is a subset of pathology, which is the "... scientific study of the nature of disease and its causes, processes, development, and consequences."[2]

History

Early explanations for mental illnesses were influenced by religious belief and superstition. Psychological conditions that are now classified as mental disorders were initially attributed to possessions by evil spirits, demons, and the devil. This idea was widely accepted up until the sixteenth and seventeenth centuries. Individuals who suffered from these so-called "possessions" were tortured as treatment.[citation needed] Doctors used this technique in hoping to bring their patients back to sanity. Those who failed to return to sanity after torture were executed.[3][unreliable source?]

The Greek physician Hippocrates was one of the first to reject the idea that mental disorders were caused by possession of demons or the devil. He firmly believed the symptoms of mental disorders were due to diseases originating in the brain. Hippocrates suspected that these states of insanity were due to imbalances of fluids in the body. He identified these fluids to be four in particular: blood, black bile, yellow bile, and phlegm.[4]

Furthermore, not far from Hippocrates, the philosopher Plato would come to argue the mind, body, and spirit worked as a unit. Any imbalance brought to these compositions of the individual could bring distress or lack of harmony within the individual. This philosophical idea would remain in perspective[vague] until the seventeenth century.[3]

In the eighteenth century's Romantic Movement, the idea that healthy parent-child relationships provided sanity became a prominent idea. Philosopher Jean-Jacques Rousseau introduced the notion that trauma in childhood could have negative implications later in adulthood.[3]

In the nineteenth century, greatly influenced by Rousseau's ideas and philosophy, Austrian psychoanalyst Sigmund Freud would bring about psychotherapy and become the father of psychoanalysis, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst. Talking therapy would originate from his ideas on the individual's experiences and the natural human efforts to make sense of the world and life.[3]

As the study of psychiatric disorders

The scientific discipline of psychopathology was founded by Karl Jaspers in 1913. It was referred to as "static understanding" and its purpose was to graphically recreate the "mental phenomenon" experienced by the client.[5]

The study of psychopathology is interdisciplinary, with contributions coming from clinical, social, and developmental psychology, as well as neuropsychology and other psychology subdisciplines; psychiatry; neuroscience generally; criminology; social work; sociology; epidemiology; statistics; and more.[6] Practitioners in clinical and academic fields are referred to as psychopathologists.

How do scientists (and people in general) distinguish between unusual or odd behavior on one hand, and a mental disorder on the other? One strategy is to assess a person along four dimensions: deviance, distress, dysfunction. and danger, known collectively as the Four D's.

The four Ds

A description of the four Ds when defining abnormality:

  1. Deviance: this term describes the idea that specific thoughts, behaviours and emotions are considered deviant when they are unacceptable or not common in society. Clinicians must, however, remember that minority groups are not always deemed deviant just because they may not have anything in common with other groups. Therefore, we define an individual's actions as deviant or abnormal when their behaviour is deemed unacceptable by the culture they belong to. However, many disorders have a relation between patterns of deviance and therefore need to be evaluated in a differential diagnostic model.[7]
  2. Distress: this term accounts for negative feelings by the individual with the disorder. They may feel deeply troubled and affected by their illness. Behaviors and feelings that cause distress to the individual or to others around him or her are considered abnormal, if the condition is upsetting to the person experiencing it. Distress is related to dysfunction by being a useful asset in accurately perceiving dysfunction in an individual’s life. These two are not always related because an individual can be highly dysfunctional and at the same time experiencing minimal stress. One should know the important characteristic of distress is not involved with dysfunction, but rather the limit to which an individual is stressed by an issue.[8]
  3. Dysfunction: this term involves maladaptive behaviour that impairs the individual's ability to perform normal daily functions, such as getting ready for work in the morning, or driving a car. This maladaptive behaviour has to be a problem large enough to be considered a diagnosis. It's highly noted to look for dysfunction across an individual's life experience because there is a chance the dysfunction may appear in clear observable view and in places where it is less likely to appear.[8] Such maladaptive behaviours prevent the individual from living a normal, healthy lifestyle. However, dysfunctional behaviour is not always caused by a disorder; it may be voluntary, such as engaging in a hunger strike.
  4. Danger: this term involves dangerous or violent behaviour directed at the individual, or others in the environment. The two important characteristics of danger is, danger to self and danger to others. When diagnosing, there is a large vulnerability of danger in which there is some danger in each diagnosis and within these diagnoses there is a continuum of severity.[8] An example of dangerous behaviour that may suggest a psychological disorder is engaging in suicidal activity. Behaviors and feelings that are potentially harmful to an individual or the individuals around them are seen as abnormal.

The p factor

Instead of conceptualizing psychopathology as consisting of several discrete categories of mental disorders, groups of psychological and psychiatric scientists have proposed a "general psychopathology" construct, named the p-factor, because of its conceptual similarity with the g factor of general intelligence. Although researchers initially conceived a tripartite (three factor) explanation for psychopathology generally, subsequent study provided more evidence for a unitary, factor that is sequentially comorbid, recurrent/chronic, and exists on a continuum of severity and chronicity. Thus, the p factor is a dimensional, as opposed to a categorical, construct.[9]

Higher scores on the p factor dimension have been found to be correlated with higher levels of functional impairment, greater incidence of problems in developmental history, and more diminished early-life brain function. In addition, those with higher levels of the p factor are more likely to have inherited a genetic predisposition to mental illness. The existence of the p factor may explain why it has been "... challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders."[9]

The p factor has been likened to the g factor of general intelligence, which is also a dimensional system by which overall cognitive ability can be defined. As psychopathology has typically been studied and implemented as a categorical system, like the Diagnostic and Statistical Manual system developed for clinicians, the dimensional system of the p factor provides an alternative conceptualization of mental disorders that might improve our understanding of psychopathology in general; lead to more precise diagnoses; and facilitate more effective treatment approaches.

Benjamin Lahey and colleagues first proposed a general psychopathology factor in 2012.[10]

As mental symptoms

The term psychopathology may also be used to denote behaviors or experiences which are indicative of mental illness, even if they do not constitute a formal diagnosis. For example, the presence of a hallucination may be considered as a psychopathological sign, even if there are not enough symptoms present to fulfill the criteria for one of the disorders listed in the DSM or ICD.

In a more general sense, any behaviour or experience which causes impairment, distress or disability, particularly if it is thought to arise from a functional breakdown in either the cognitive or neurocognitive systems in the brain, may be classified as psychopathology. It remains unclear how strong the distinction between maladaptive traits and mental disorders actually is,[11][12] e.g. neuroticism is often described as the personal level of minor psychiatric symptoms.[13]

Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an guideline for the diagnosis and understanding of mental disorders. It serves as reference for a range of professionals in medicine and mental health in the United States particularly. These professionals include psychologists, counselors, physicians, social workers, psychiatric nurses and nurse practitioners, marriage and family therapists, and more.[14]

Examples of mental disorders classified within the DSM include:

  • Major depressive disorder is a mood disorder defined by symptoms of loss of motivation, decreased mood, lack of energy and thoughts of suicide.
  • Bipolar disorders are mood disorders characterized by depressive and manic episodes of varying lengths and degrees.
  • Dysthymia is a mood disorder similar to depression. Characterized by a persistent low mood, dysthymia is a less debilitating form of depression with no break in ordinary functioning.
  • Schizophrenia is characterized by altered perception of reality, including delusional thoughts, hallucinations, and disorganized speech and behaviour. Most cases arise in patients in their late teens or early adulthood, but can also appear later on in life.[15]
  • Borderline personality disorder occurs in early adulthood for most patients; specific symptoms include patterns of unstable and intense relationships, chronic feelings of emptiness, emotional instability, paranoid thoughts, intense episodes of anger, and suicidal behavior.[16]
  • Bulimia nervosa "binge and purge", an eating disorder specified as reoccurring episodes of uncontrollable binge eating followed by a need to vomit, take laxatives, or exercise excessively. Usually begins occurring at adolescence but most individuals do not seek help until later in life when it can be harder to change their eating habits.[17]
  • Phobias Found in people of all ages. Characterized by an abnormal response to fear or danger. Persons diagnosed with Phobias suffer from feelings of terror and uncontrollable fear, exaggerated reactions to danger that in reality is not life-threatening, and is usually accompanied by physical reactions related to extreme fear: panic, rapid heartbeat, and/or shortened breathing.[18]
  • Pyromania this disorder is indicated by fascination, curiosity, or attraction to purposely setting things on fire. Pyromaniacs find pleasure and/or relief by watching things burn. Can occur due to delusional thinking, impaired judgement due to other mental disorders, or simply as aggressive behavior to express anger.[19]

DSM/RDoc debate

Some scholars have argued that field should switch from the DSM categorical approach of mental disorders to the Research Domain Criteria (RDoC) dimensional approach of mental disorders, although the consensus at present is to retain DSM for treatment, insurance, and related purposes, while emphasizing RDoC conceptualizations for planning and funding psychiatric research.[20]

See also

General:

Footnotes

  1. ^ For example, schizophrenia usually causes amotivation, which, along with other symptoms and functional limitations, contributes to some patients becoming homeless, which in turn renders them more vulnerable to physical and sexual assault and other crimes. Amotivation is a symptom, whereas homelessness and victimization are manifestations (consequences) of the mental illness.
  2. ^ To provide a richer understanding of what is meant by psychopathology, particularly the phenomonelogy (internal experience) of those afflicted with a mental disorder, consider the word's etymology. Psychopathology is derived from three roots: (1) psyche (noun), from Ancient Greek ψυχή (psukhē, "soul, breath, mind, life-breath, spirit"). (2) pathos (noun), from Ancient Greek πάθος, which is from πάσχω (paskhō, "I feel, suffer"), and in this context means a condition or state in which the individual experiences pain, loss, anguish, hurt, and woe. (3) -ology (suffix), from Ancient Greek -λογία -logia, the study of (see pathology). Thus, psychopathology is the scientific study of abnormal psychology, i.e., abnormal perceptions, thoughts, beliefs, emotions, and behavior that lead to distress, pain and misery, even to the point that an afflicted person feels as if their very "life-breath" (soul) is being damaged or sucked out.
  3. ^ The prepositional phrase, "At least conceptually" refers to the fact that the two disciplines--pathology and psychopathology--have largely developed independent of each other.

References

  1. ^ Oxford English Dictionary. OED Online (3rd ed.). Oxford, England, UK: Oxford University Press. 2007. psychopathology, n. - 1. The study of pathological mental and behavioural processes ...; 2. Abnormal psychology; an abnormal psychological process or state.
  2. ^ American Heritage Dictionary of the English Language (6th ed.). Houghton Mifflin Harcourt. 2016.
  3. ^ a b c d Heffner C. "Chapter 9: Section 1: Psychopathology". AllPsych.com. AllPsych. Retrieved 18 February 2015.
  4. ^ Hamshar M. "The History of Psychopathology". Suite. Retrieved 18 February 2015.
  5. ^ Marlet JJ (2015). "Development of cranial hyperostosis. A radiological approach to a process". Radiologia Clinica Et Biologica. 43 (6): 473–82. PMC 4421897.
  6. ^ Shah SA, Mushtaq S, Naseer MN, Ahmad A, Sharma G, Kovur H (2017). A text book of psycholopathology. RED'SHINE Publication. Pvt. Ltd. ISBN 9789386483201.
  7. ^ Davis T (2009). "Conceptualizing Psychiatric Disorders Using "Four D's" of Diagnoses". The Internet Journal of Psychiatry. 1 (1): 1. Retrieved 7 March 2018.
  8. ^ a b c Davis, T (2009). "Conceptualizing Psychiatric Disorders Using "Four D's" of Diagnoses". The Internet Journal of Psychiatry. 1 (1): 2. Retrieved 7 March 2018.
  9. ^ a b Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S, et al. (March 2014). "The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders?". Clinical Psychological Science. 2 (2): 119–137. doi:10.1177/2167702613497473. PMC 4209412. PMID 25360393.
  10. ^ Lahey BB, Applegate B, Hakes JK, Zald DH, Hariri AR, Rathouz PJ (November 2012). "Is there a general factor of prevalent psychopathology during adulthood?". Journal of Abnormal Psychology. 121 (4): 971–7. doi:10.1037/a0028355. PMC 4134439. PMID 22845652.
  11. ^ Jeronimus BF, Kotov R, Riese H, Ormel J (October 2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506.
  12. ^ Ormel J, Laceulle OM, Jeronimus BF (2014). "Why Personality and Psychopathology Are Correlated: A Developmental Perspective Is a First Step but More Is Needed". European Journal of Personality. 28 (4): 396–98. doi:10.1002/per.1971.
  13. ^ Ormel J, Jeronimus BF, Kotov R, Riese H, Bos EH, Hankin B, Rosmalen JG, Oldehinkel AJ (July 2013). "Neuroticism and common mental disorders: meaning and utility of a complex relationship". Clinical Psychology Review. 33 (5): 686–697. doi:10.1016/j.cpr.2013.04.003. PMC 4382368. PMID 23702592.
  14. ^ "DSM". American Psychiatric Association. Retrieved 12 February 2015.
  15. ^ "Understanding Schizophrenia". Helpguide.org. HelpGuide.org. Retrieved 12 February 2015.
  16. ^ "Borderline Personality Disorder Symptoms". PsychCentral. Retrieved 12 February 2015.
  17. ^ "Bulimia Nervosa Symptoms". PsychCentral. Retrieved 12 February 2015.
  18. ^ "Phobias". American Psychiatric Association. American Psychiatric Association. Retrieved 18 February 2015.
  19. ^ "Pyromania Symptoms". PsychCentral.com. PsychCentral. Retrieved 18 February 2015.
  20. ^ Casey BJ, Craddock N, Cuthbert BN, Hyman SE, Lee FS, Ressler KJ (November 2013). "DSM-5 and RDoC: progress in psychiatry research?". Nature Reviews. Neuroscience. 14 (11): 810–4. doi:10.1038/nrn3621. PMC 4372467. PMID 24135697.

Further reading

  • Atkinson, L et al. (2004). Attachment Issues in Psychopathology and Intervention. Lawrence Erlbaum.
  • Berrios, G.E.(1996) The History of Mental Symptoms: Descriptive Psychopathology since the 19th century. Cambridge, Cambridge University Press, ISBN 0-521-43736-9
  • Freud, S (1916) The Psychopathology of Everyday Life. MacMillan.
  • Keating, D P et al. (1991). Constructivist Perspectives on Developmental Psychopathology and Atypical Development. Lawrence Erlbaum.
  • Maddux, J E et al. (2005). Psychopathology: Foundations for a Contemporary Understanding. Lawrence Erlbaum.
  • McMaster University. (2011). Psychological disorders. In Discover psychology (pp. 154–155, 157-158, 162-164) [Introduction]. Toronto, ON: Nelson Education.
  • Sims, A. (2002) Symptoms in the Mind: An Introduction to Descriptive Psychopathology (3rd ed). Elsevier. ISBN 0-7020-2627-1
  • Widiger, T A et al. (2000). Adult Psychopathology: Issues and Controversies. Annual Review of Psychology.

External links

  • Schizophrenia Research Forum
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