Psychopathology

Last updated November 06, 2024

Psychopathology is the study of mental illness. It includes the signs and symptoms of all mental disorders. The field includes abnormal cognition, maladaptive behavior, and experiences which differ according to social norms. This discipline is an in-depth look into symptoms, behaviors, causes, course, development, categorization, treatments, strategies, and more.

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.^[1]

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, and instead looked to natural causes. 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. This later became the basis of the chemical imbalance theory used widely within the present.

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 until the seventeenth century. It was later challenged by Laing (1960) along with Laing and Esterson (1964) who noted that it was the family environment that led to the formation of adaptive strategies.

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.

In the 1600s and 1700s insane asylums started to be opened to house those with mental disorders.^[2] Asylums were places where restraint techniques and treatments could be tested on patients who were confined. These were early precursors for psychiatric hospitals.

In 1875 the German book Textbook of Forensic Psychopathology was published, written by Richard von Krafft-Ebing, which became a standard psychiatric textbook for Universities across Germany.^[3]

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. A few years earlier, in 1899, the German book Lehrbuch der Psychopathologischen Untersuchungs-Methoden was published by Robert Sommer.

Psychoanalysis

Sigmund Freud proposed a 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.^[4]

As the study of psychiatric disorders

The study of psychopathology is interdisciplinary, with contributions coming from clinical psychology, abnormal psychology, social psychology, and developmental psychology, as well as neuropsychology and other psychology subdisciplines. Other related fields include psychiatry, neuroscience, criminology, social work, sociology, epidemiology, and statistics.^[5]

Psychopathology can be broadly separated into descriptive and explanatory. Descriptive psychopathology involves categorising, defining and understanding symptoms as reported by people and observed through their behaviour which are then assessed according to a social norm. Explanatory psychopathology looks to find explanations for certain kinds of symptoms according to theoretical models such as psychodynamics, cognitive behavioural therapy or through understanding how they have been constructed by drawing upon Constructivist Grounded Theory (Charmaz, 2016) or Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2013).^[6]

There are several ways to characterise the presence of psychopathology in an individual as a whole. One strategy is to assess a person along four dimensions: deviance, distress, dysfunction, and danger, known collectively as the four Ds. Another conceptualisation, the p factor, sees psychopathology as a general, overarching construct that influences psychiatric symptoms.

Mental Disorders

Mental disorders are defined by a set of characteristic features, that is more than just one symptom. In order to be classified for diagnosis, the symptoms cannot represent an expected response to a common stress or loss that is related to an event. Syndromes are a set of simultaneous symptoms that represent a disorder. Common mental health disorders include depression, generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).^[7]

Depression is one of the most common and most debilitating mental disorders worldwide.^[8] It affects how individuals think, feel, and act. Symptoms vary depending on each individual person and include feeling sad, irritable, hopeless, or losing interest in activities once enjoyed.

Generalized anxiety disorder is feeling worried or nervous more frequently than what correlates to real-life stressors. It is more common in women than men and includes symptoms such as having trouble controlling their worries or feelings of nervousness, or feeling restless and have trouble relaxing.^[9]

The Four Ds

A description of the four Ds when defining abnormality:

Deviance is variation from statistical norms that result in a conflict with society. This term describes the idea that specific thoughts, behaviors 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.^[10]
Distress has to do with the discomfort that is experience by the person with the disorder. 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 individuals or to others around them 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 experience minimal stress. The important characteristic of distress is not dysfunction; rather it is the upsetting events themselves and the way we respond to them.^[11]
Dysfunction involves an inability to maladaptive behavior that impairs the individual's ability to perform normal daily functions. It includes dysfunction in the psychological, biological, or developmental processes that are associated with mental functioning.^[12] This maladaptive behavior has to be significant 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.^[10] 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.
Duration is useful for clinicians to use as a criterion for diagnosis. Most symptoms have a specific duration that they last before being diagnosed. Can be harmful as not every person's experience is the same.^[13]

The p factor

Benjamin Lahey and colleagues first proposed a general "psychopathology factor" in 2012,^[14] or simply "p factor". This construct shares its conceptual similarity with the g factor of general intelligence. Instead of conceptualising psychopathology as consisting of several discrete categories of mental disorders, the p factor is dimensional and influences whether psychiatric symptoms in general are present or absent. The symptoms that are present then combine to form several distinct diagnoses. The p factor is modelled in the Hierarchical Taxonomy of Psychopathology. Although researchers initially conceived a three-factor explanation for psychopathology generally, subsequent study provided more evidence for a single factor that is sequentially comorbid, recurrent/chronic, and exists on a continuum of severity and chronicity.^[15]

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."^[15]

A 2020 review of the p factor found that many studies support its validity and that it is generally stable throughout one's life. A high p factor is associated with many adverse effects, including poor academic performance, impulsivity, criminality, suicidality, reduced foetal growth, lower executive functioning, and a greater number of psychiatric diagnoses. A partial genetic basis for the p factor has also been supported.^[16]

Alternatively, the p factor has also been interpreted as an index of general impairment rather than being a specific index that causes psychopathology.^[16]

As mental symptoms

The term psychopathology may also be used to denote behaviours or experiences which are indicative of mental illness, even if they do not constitute a formal diagnosis. For example, the presence of hallucinations may be considered as a psychopathological sign, even if there are not enough symptoms present to fulfil 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,^[17]^[18] e.g. neuroticism is often described as the personal level of minor psychiatric symptoms.^[19]

Diagnostic and Statistical Manual of Mental Disorders

Main article: Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guideline for the diagnosis and understanding of mental disorders. The American Psychiatric Association (APA) sponsors the editing, writing, reviewing and publishing of this book. It is a reference book on mental health and brain-related conditions and disorders. It serves as reference for a range of professionals in medicine and mental health in the United States particularly. These professionals include psychologists, counsellors, physicians, social workers, psychiatric nurses and nurse practitioners, marriage and family therapists, and more. The current DSM is the fifth, most recent edition of this book. It was released in May 2013.^[20] Each edition makes significant changes to the classification of disorders.

Research Domain Criteria

Main article: Research Domain Criteria

The RDoC framework is a set of research principles for investigating mental disorders. It is meant to create a new approach to mental illness that leads to better diagnosis, prevention, intervention, and cures. It is not necessarily meant to serve as a diagnostic guide or replace the DSM, however, it is meant to examine various degrees of dysfunction. It was developed by the US National Institute of Mental Health (NIMH).^[21] It aims to address heterogeneity by providing a more symptom based framework for understanding mental disorders. It relied on dimensions that span the range from normal to abnormal and allows investigators to work with a larger database. It uses six major functional domains to examine neurobehavioral functioning. Different aspects of each domain are represented by constructs which are studied along the full range of functioning. Together all of the domains form a matrix that could represent research ideas. It is a heuristic, and acknowledges that research topics will change and grow as science emerges.^[22]

Related Research Articles

<i>Diagnostic and Statistical Manual of Mental Disorders</i> American psychiatric classification

The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is an internationally accepted manual on the diagnosis and treatment of mental disorders, though it may be used in conjunction with other documents. Other commonly used principal guides of psychiatry include the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual. However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world, and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckless breaking of rules, in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors", and is often seen as the precursor to antisocial personality disorder; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old. Conduct disorder may result from parental rejection and neglect and can be treated with family therapy, as well as behavioral modifications and pharmacotherapy. Conduct disorder is estimated to affect 51.1 million people globally as of 2013.

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind–body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

Avolition or amotivation, as a symptom of various forms of psychopathology, is the decrease in the ability to initiate and persist in self-directed purposeful activities. Such activities that appear to be neglected usually include routine activities, including hobbies, going to work or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations. It is a disorder of diminished motivation.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Abnormality is a behavioral characteristic assigned to those with conditions that are regarded as dysfunctional. Behavior is considered to be abnormal when it is atypical or out of the ordinary, consists of undesirable behavior, and results in impairment in the individual's functioning. As applied to humans, abnormality may also encompass deviance, which refers to behavior that is considered to transgress social norms. The definition of abnormal behavior in humans is an often debated issue in abnormal psychology.

<span class="mw-page-title-main">Diathesis–stress model</span> Psychological theory

The diathesis-stress model, also known as the vulnerability–stress model, is a psychological theory that attempts to explain a disorder, or its trajectory, as the result of an interaction between a predispositional vulnerability, the diathesis, and stress caused by life experiences. The term diathesis derives from the Greek term (διάθεσις) for a predisposition or sensibility. A diathesis can take the form of genetic, psychological, biological, or situational factors. A large range of differences exists among individuals' vulnerabilities to the development of a disorder.

The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, some providers instead rely on the International Statistical Classification of Diseases and Related Health Problems (ICD), and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.

Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

In personality pathology, dimensional models of personality disorders conceptualize personality disorders as qualitatively rather than quantitatively different from normal personality. They consist of extreme, maladaptive levels of certain personality characteristics. Within the context of personality psychology, a "dimension" refers to a continuum on which an individual can have various levels of a characteristic, in contrast to the dichotomous categorical approach in which an individual does or does not possess a characteristic. According to dimensional models personality disorders are classified according to which characteristics are expressed at which levels. This stands in contrast to the traditional categorical models of classification, which are based on the boolean presence or absence of symptoms and do not take into account levels of expression of a characteristic or the presence of any underlying dimension.

The Research Domain Criteria (RDoC) project is an initiative of personalized medicine in psychiatry developed by US National Institute of Mental Health (NIMH). In contrast to the Diagnostic and Statistical Manual of Mental Disorders (DSM) maintained by the American Psychiatric Association (APA), RDoC aims to address the heterogeneity in the current nosology by providing a biologically-based, rather than symptom-based, framework for understanding mental disorders. "RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness."

Externalizing disorders are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize their maladaptive emotions and cognitions, such feelings and thoughts are externalized in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality.

Maladaptive daydreaming, also called excessive daydreaming, is when an individual experiences excessive daydreaming that interferes with daily life. It is a proposed diagnosis of a disordered form of dissociative absorption, associated with excessive fantasy that is not recognized by any major medical or psychological criteria. Maladaptive daydreaming can result in distress, can replace human interaction and may interfere with normal functioning such as social life or work. Maladaptive daydreaming is not a widely recognized diagnosis and is not found in any major diagnostic manual of psychiatry or medicine. The term was coined in 2002 by Eli Somer of the University of Haifa. Somer's definition of the proposed condition is "extensive fantasy activity that replaces human interaction and/or interferes with academic, interpersonal, or vocational functioning." There has been limited research outside of Somer's.

The Hierarchical Taxonomy Of Psychopathology (HiTOP) consortium was formed in 2015 as a grassroots effort to articulate a classification of mental health problems based on recent scientific findings on how the components of mental disorders fit together. The consortium is developing the HiTOP model, a classification system, or taxonomy, of mental disorders, or psychopathology, aiming to prioritize scientific results over convention and clinical opinion. The motives for proposing this classification were to aid clinical practice and mental health research. The consortium was organized by Drs. Roman Kotov, Robert Krueger, and David Watson. At inception it included 40 psychologists and psychiatrists, who had a record of scientific contributions to classification of psychopathology The HiTOP model aims to address limitations of traditional classification systems for mental illness, such as the DSM-5 and ICD-10, by organizing psychopathology according to evidence from research on observable patterns of mental health problems.

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