MENTAL DISORDER

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Introduction
any illness with significant psychological or behavioral manifestations that is associated with either a painful or
distressing symptom or an impairment in one or more important areas of functioning. Mental disorders, in particular
their consequences and their treatment, are of more concern and receive more attention now than in the past. Mental
disorders have become a more prominent subject of attention for several reasons. They have always been common,
but, with the eradication or successful treatment of many of the serious physical illnesses that formerly afflicted
humans, mental illness has become a more noticeable cause of suffering and accounts for a higher proportion of those
disabled by disease. Moreover, the public has come to expect the medical and mental health professions to help it
obtain an improved quality of life in its mental as well as physical functioning. And indeed, there has been a
proliferation of both pharmacological and psychotherapeutic treatments. The transfer of many psychiatric patients,
some still showing conspicuous symptoms, from mental hospitals into the community has also increased the public's
awareness of the importance and prevalence of mental illness. There is no simple definition of mental disorder that is
universally satisfactory. This is partly because mental states or behaviour that are viewed as abnormal in one culture
may be regarded as normal or acceptable in another, and in any case it is difficult to draw a line clearly demarcating
healthy from abnormal mental functioning. A narrow definition of mental illness would insist upon the presence of
organic disease of the brain, either structural or biochemical. An overly broad definition would define mental illness as
simply being the lack or absence of mental healththat is to say, a condition of mental well-being, balance, and
resilience in which the individual can successfully work and function and in which the individual can both withstand
and learn to cope with the conflicts and stresses encountered in life. A more generally useful definition ascribes mental
disorder to psychological, social, biochemical, or genetic dysfunctions or disturbances in the individual. A mental
illness can have an effect on every aspect of a person's life, including thinking, feeling, mood, and outlook and such
areas of external activity as family and marital life, sexual activity, work, recreation, and management of material
affairs. Most mental disorders negatively affect how individuals feel about themselves and impair their capacity for
participating in mutually rewarding relationships.
Major Point
Psychopathology is the systematic study of the significant causes, processes, and symptomatic manifestations of
mental disorders. The meticulous study, observation, and inquiry that characterize the discipline of psychopathology
are, in turn, the basis for the practice of psychiatry (i.e., the science and practice of diagnosing and treating mental
disorders as well as dealing with their prevention). Psychiatry, psychology, and related disciplines such as clinical
psychology and counseling embrace a wide spectrum of techniques and approaches for treating mental illnesses.
These include the use of psychoactive drugs to correct biochemical imbalances in the brain or otherwise to relieve
depression, anxiety, and other painful emotional states. Another important group of treatments is the psychotherapies,
which seek to treat mental disorders by psychological means and which involve verbal communication between the
patient and a trained person in the context of a therapeutic interpersonal relationship between them. Different modes
of psychotherapy focus variously on emotional experience, cognitive processing, and overt behaviour. This views
discusses the types, causes, and treatment of mental disorders. Neurological diseases (see neurology) with behavioral
manifestations are treated in nervous system disease. Alcoholism and other substance use disorders are discussed in
alcoholism and drug use. Disorders of sexual functioning and behaviour are treated in sexual behaviour, human. Tests
used to evaluate mental health and functioning are discussed in psychological testing. The various theories of
personality structure and dynamics are treated in personality, while human emotion and motivation are discussed in
emotion and motivation. See also personality disorder; psychopharmacology; psychotherapy.

Types and causes of mental disorders

Classification and epidemiology
Psychiatric classification attempts to bring order to the enormous diversity of mental symptoms, syndromes, and
illnesses that are encountered in clinical practice. Epidemiology is the measurement of the prevalence, or frequency of
occurrence, of these psychiatric disorders in different human populations.
Classification
Diagnosis is the process of identifying an illness by studying its signs and symptoms and by considering the patient's
history. Much of this information is gathered by the mental health practitioner (e.g., psychiatrist, psychotherapist,
psychologist, social worker, or counselor) during initial interviews with the patient, who describes the main
complaints and symptoms and any past ones and briefly gives a personal history and current situation. The practitioner
may administer any of several psychological tests to the patient and may supplement these with a physical and a
neurological examination. These data, along with the practitioner's own observations of the patient and of the patient's
interaction with the practitioner, form the basis for a preliminary diagnostic assessment. For the practitioner, diagnosis
involves finding the most prominent or significant symptoms, on the basis of which the patient's disorder can be
assigned to a category as a first stage toward treatment. Diagnosis is as important in mental health treatment as it is in
medical treatment. Classification systems in psychiatry aim to distinguish groups of patients who share the same or
related clinical symptoms in order to provide an appropriate therapy and accurately predict the prospects of recovery
for any individual member of that group. Thus, a diagnosis of depression, for example, would lead the practitioner to
consider antidepressant drugs when preparing a course of treatment. Psychiatry is hampered by the fact that the cause
of many mental illnesses is unknown, and so convenient diagnostic distinctions cannot be made among such illnesses
as they can, for instance, in infectious medicine, where infection with a specific type of bacterium is a reliable
indicator for a diagnosis of tuberculosis. But the greatest difficulties presented by mental disorders as far as
classification and diagnosis are concerned are that the same symptoms are often found in patients with different or
unrelated disorders and a patient may show a mix of symptoms properly belonging to several different disorders.
Thus, although the categories of mental illness are defined according to symptom patterns, course, and outcome, the
illnesses of many patients constitute intermediate cases between such categories, and the categories themselves may
not necessarily represent distinct disease entities and are often poorly defined. The two most frequently used systems
of psychiatric classification are the International Statistical Classification of Diseases and Related Health Problems
(ICD), produced by the World Health Organization, and the Diagnostic and Statistical Manual of Mental Disorders
(DSM), produced by the American Psychiatric Association. The 10th revision of the former, published in 1992 The
DSM differs from the ICD in its introduction of precisely described criteria for each diagnostic category; its
categorizations are usually based upon the detailed description of symptoms. The DSM-IV has been widely used,
especially in the United States, and its detailed descriptions of diagnostic criteria have been useful in eradicating the
inconsistencies of earlier classifications. However, there are still some major problems in its everyday clinical use.
Chief among them is the DSM's innovative and controversial abandonment of the general categories of psychosis and
neurosis in its classificatory scheme. These terms have been and still are widely used to distinguish between classes of
mental disorders, though there are various mental illnesses, such as personality disorders, that cannot be classified as
either psychoses or neuroses.
Psychoses
Psychoses are major mental illnesses that are characterized by severe symptoms such as delusions, hallucinations,
disturbances of the thinking process, and defects of judgment and insight. Persons with psychoses exhibit a
disturbance or disorganization of thought, emotion, and behaviour so profound that they are often unable to function in
everyday life and may be incapacitated or disabled. Such individuals are often unable to realize that their subjective
perceptions and feelings do not correlate with objective reality, a phenomenon evinced by persons with psychoses who
do not know or will not believe that they are ill despite the distress they feel and their obvious confusion concerning
the outside world. Traditionally, the psychoses have been broadly divided into organic and functional psychoses.
Organic psychoses were believed to result from a physical defect of or damage to the brain. Functional psychoses
were believed to have no physical brain disease evident upon clinical examination. Much recent research suggests that
this distinction between organic and functional is probably inaccurate. Most psychoses are now believed to result from
some structural or biochemical change in the brain.

Neuroses
Neuroses, or psychoneuroses, are less-serious disorders in which people may experience negative feelings such as
anxiety or depression. Their functioning may be significantly impaired, but personality remains relatively intact, the
capacity to recognize and objectively evaluate reality is maintained, and they are basically able to function in everyday
life. In contrast to people with psychoses, neurotic patients know or can be made to realize that they are ill, and they
usually want to get well and return to a normal state. Their chances for recovery are better than those of persons with
psychoses. The symptoms of neurosis may sometimes resemble the coping mechanisms used in everyday life by most
people, but in neurotics these defensive reactions are inappropriately severe or prolonged in response to an external
stress. Anxiety disorders, phobic disorder (exhibited as unrealistic fear or dread), conversion disorder (formerly
known as hysteria), obsessive-compulsive disorder, and depressive disorders have been traditionally classified as
neuroses.
Epidemiology
Epidemiology is the study of the distribution of disease in different populations. Prevalence denotes the number of
cases of a condition present at a particular time or over a specified period, while incidence denotes the number of new
cases occurring in a defined time period. Epidemiology is also concerned with the social, economic, or other contexts
in which mental illnesses arise. The understanding of mental disorders is aided by knowledge of the rate and
frequency with which they occur in different societies and cultures. Looking at the worldwide prevalence of mental
disorders reveals many surprising findings. It is remarkable, for instance, that the lifetime risk of developing
schizophrenia, even in widely different cultures, is approximately 1 percent. Gradual historical changes in the
incidence and prevalence of particular disorders have often been described, but it is very difficult to obtain firm
evidence that such changes have actually occurred. On the other hand, prevalence has been seen to increase for a few
syndromes because of general changes in living conditions over time. For example, dementia inevitably develops in
some 20 percent of those persons over age 80, so, with the increase in life expectancy common to developed countries,
the number of people with dementia is bound to increase. There also seems to be some evidence of an increased
prevalence of mood disorders over the past century. Given such objections, one ambitious study conducted by the
National Institute of Mental Health in the United States examined thousands of persons in several American localities
and yielded the following results concerning the prevalence of mental disorders in the general population. About 1
percent of those surveyed were found to have schizophrenia, more than 9 percent had depression, and about 13 percent
had phobias or other anxiety disorders. There are also marked sex differences in the incidence of certain types of
mental illness. For instance, anorexia nervosa is 20 times more common in girls than in boys; men tend to develop
schizophrenia at a younger age than women; depression is more common in women than in men; and many sexual
deviations occur almost exclusively in men.
Theories of causation
Very often the etiology, or cause, of a particular type of mental disorder is unknown or is understood only to a very
limited extent. The situation is complicated by the fact that a mental disorder such as schizophrenia may be caused by
a combination and interaction of several factors, including a probable genetic predisposition to develop the disease, a
postulated biochemical imbalance in the brain, and a cluster of stressful life events that help to precipitate the actual
onset of the illness. The predominance of these and other factors probably varies from person to person in
schizophrenia. A similarly complex interaction of constitutional, developmental, and social factors can influence the
formation of mood and anxiety disorders. No single theory of causation can explain all mental disorders or even all
those of a particular type. Moreover, the same type of disorder may have different causes in different persons: e.g., an
obsessive-compulsive disorder may have its origins in a biochemical imbalance, in an unconscious emotional conflict,
in faulty learning processes, or in a combination of these. The fact that quite different therapeutic approaches can
produce equal improvements in different patients with the same type of disorder underscores the complex and
ambiguous nature of the causes of mental illness. The major theoretical and research approaches to the causation of
mental disorders are treated below.
Genetics
The study of the genetic causes of mental disorders involves both the laboratory analysis of the human genome and
the statistical analysis of the frequency of a particular disorder's occurrence among individuals who share related
genesi.e., family members and particularly twins. Family risk studies compare the observed frequency of

occurrence of a mental illness in close relatives of the patient with its frequency in the general population. First-degree
relatives (parents, siblings, and children) share 50 percent of their genetic material with the patient, and higher rates of
the illness in these relatives than expected indicate a possible genetic factor. In twin studies the frequency of
occurrence of the illness in both members of pairs of identical (monozygous) twins is compared with its frequency in
both members of a pair of fraternal (dizygous) twins. A higher concordance for disease among the identical than the
fraternal twins suggests a genetic component. Further information on the relative importance of genetic and
environmental factors accrues from comparing identical twins reared together with those reared apart. Adoption
studies comparing adopted children whose biological parents had the illness with those whose parents did not can also
be useful in separating biological from environmental influences.Such studies have demonstrated a clear role for
genetic factors in the causation of schizophrenia. When one parent is found to have the disorder, the probability of that
person's children developing schizophrenia is at least 10 times higher (about a 12 percent risk probability) than it is for
children in the general population (about a 1 percent risk probability). If both parents have schizophrenia, the
probability of their children developing the disorder is anywhere from 35 to 65 percent. If one member of a pair of
fraternal twins develops schizophrenia, there is about a 12 percent chance that the other twin will too. If one member
of a pair of identical twins has schizophrenia, the other identical twin has at least a 40 to 50 percent chance of
developing the disorder. Although genetic factors seem to play a less significant role in the causation of other
psychotic and personality disorders, studies have demonstrated a probable role for genetic factors in the causation of
many mood disorders and some anxiety disorders.
Major diagnostic categories
Organic mental disorders
This category includes both those psychological or behavioral abnormalities that arise from structural disease of the
brain and also those that arise from brain dysfunction caused by disease outside the brain. These conditions differ from
those of other mental illnesses in that they have a definite and ascertainable causei.e., brain disease. However, the
importance of the distinction (between organic and functional) has become less clear as research has demonstrated that
brain abnormalities are associated with many psychiatric illnesses. When possible, treatment is aimed at both the
symptoms and the underlying physical dysfunction in the brain.
Family therapy
Family therapists view the family as the patient or client and as more than the sum of its members. The family as
a focus for treatment usually comprises the members who live under the same roof, sometimes supplemented by
relatives who live elsewhere or by nonrelatives who share the family home. Therapy with couples may be considered
as a special type of family therapy. Family therapy may be appropriate when the person referred for treatment has
symptoms clearly related to such disturbances in family function as marital discord, distorted family roles, and parentchild conflict or when the family as a unit asks for help. It is not appropriate when a single individual has a severe
disorder needing specific treatment in its own right. The many theoretical approaches include psychoanalytic,
systems-theory, and behavioral models. In the first approach the analyst is concerned with the family's past as the
cause of the present and pays attention to psychodynamic aspects of the individual members and of the family as a
whole. The analyst also makes numerous interpretations while attempting to increase the insight of the members. The
systems therapist, by comparison, is interested in the present rather than the past and is often not concerned with
promoting insight, working instead to change the family system, perhaps by altering the implicit and fixed rules under
which it functions so that it can do so more effectively.
Finally, the behaviour therapist is concerned with behaviour patternsespecially those that pinpoint reinforcements of
behaviour seen as undesirable by other family members. Members specify the changes in behaviour that they wish to
see in each other, and strategies are devised to reinforce the desired behaviours. This approach has been shown to be
effective in work with couples, when one partner promises some particular change on the condition that the other
reciprocates.
Additional Reading And References

MLA Style: "mental disorder." Encyclopdia Britannica. Encyclopdia Britannica Ultimate Reference
Suite. Chicago: Encyclopdia Britannica, 2012.

APA Style: mental disorder. (2012). Encyclopdia Britannica. Encyclopdia Britannica Ultimate Reference
Suite. Chicago: Encyclopdia Britannica.

BY: DEDE. H
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