Psychopathology[a] is the scientific study of mental disorders, including efforts to understand their genetic, biological, psychological, and social causes; effective classification schemes (nosology); course across all stages of development; manifestations; and treatment. The term may also refer to the manifestation of behaviors that indicate the presence of a mental disorder.
The word psychopathology has a Greek origin: 'psyche' means "soul", 'pathos' is defined as "suffering", and 'logos' is "the study of". Wholly, psychopathology is defined as the origin of mental disorders, how they develop, and the symptoms they might produce in a person.
Patients with mental disorders are normally treated by psychiatrists, or psychologists, who both specialize in mental health and diagnose and treat patients through medication or psychotherapy. These professionals systematically diagnose individuals with mental disorders using specific diagnostic criteria and symptomatology found within the Diagnostic and Statistical Manual of Mental Disorders.
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. Doctors used this technique in hoping to bring their patients back to sanity. Those who failed to return to sanity after torture were executed.
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.
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.
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 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.
As the study of psychiatric disorders
The scientific discipline of psychopathology was founded by Karl Jaspers in 1913, whose object of study was "mental phenomena".
Many different professions may be involved in studying mental disorders or distress. Most notably, psychiatrists and clinical psychologists are particularly interested in this area and may either be involved in clinical treatment of mental illness, or research into the origin, development and manifestations of such states, or often, both.
More widely, psychopathology may be involved in many different specialties. For example, a neuroscientist may focus on brain changes related to mental illness. Therefore, someone who is referred to as a psychopathologist, may be one of any number of professions who have specialized in studying this area.
Psychiatrists in particular are interested in descriptive psychopathology, which has the aim of describing the symptoms and syndromes of mental illness. This is both for the diagnosis of individual patients (to see whether the patient's experience fits any pre-existing classification), or for the creation of diagnostic systems (such as the Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases and Related Health Problems) which define which signs and symptoms should make up a diagnosis, and how experiences and behaviours should be grouped in particular diagnoses (e.g. clinical depression, paraphrenia, paranoia, schizophrenia).
Before diagnosing a psychological disorder, clinicians must study the themes, also known as abnormalities, within psychological disorders. The most prominent themes consist of: deviance, distress, dysfunction and danger. These themes are known as the four Ds, which define abnormality.
The four Ds
A description of the four Ds when defining abnormality:
- 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.
- 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.
- 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. 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.
- Danger: this term involves dangerous or violent behaviour directed at the individual, or others in the environment. 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.
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,e.g. neuroticism is often described as the personal level of minor psychiatric symptoms.
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an official guideline for the diagnosis of psychological disorders. It serves as reference for a range of professionals in the field of health and mental health. These professionals include psychologists, counselors, physicians, social workers, and therapists.
Formerly, for a diagnosis to be made, two levels of criteria within the DSM must be met. First, the disordered behavior must originate within the person, and it must not be a reaction due to external factors. Second, the disorder must be involuntary, meaning that the individual cannot physically or mentally control their symptoms.
Current diagnostic criteria within the DSM does not recognize this requirement. Instead, it recognizes that specific diagnoses may indeed be reactions to environmental or external factors (e.g. Posttraumatic stress disorder). The fifth edition of the DSM uses specific diagnostic criteria for each individual disorder listed within. As the DSM-5 is meant to categorize the disorders, at times, not all mental disorders fit within one particular category. In other words, symptoms may ovelap.
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.
- 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.
- 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.
- 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.
- 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.
The previous version, the DSM-IV TR, uses a multi-axial system of classification, which requires the individual to be placed on 5 separate axes which describe possible mental health factors. Most disorders are recorded on axis I, which are state dependent. Axis II describes disorders that are trait dependent. Axis III describes current physical conditions, Axis IV describes psychosocial or environmental stressors, and lastly, Axis V is used to discuss the individuals global assessment of functioning.
- Axis I: Most psychological disorders
- Axis II: Personality disorders and mental retardation
- Axis III: General medical condition
- Axis IV: Psychosocial and environmental stressors
- Axis V: Global assessment of functioning
The current version, the DSM-5 no longer uses an axis system to diagnose individuals. The DSM-5 instead uses a thorough system of diagnostic criteria that accounts for comorbidity and differential diagnoses.
- ^ 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 ???? (psukh?, "soul, breath, mind, life-breath, spirit"). (2) pathos (noun), from Ancient Greek ?????, which is from ????? (paskh?, "I feel, suffer"), and in this context means a condition or state in which the individual experiences pain, suffering, death, misfortune, or misery. (3) -ology (suffix), from Ancient Greek -????? -logia, the study of (see pathology). Psychopathology is the study and research of psychological disorders. A psychological disorder is the "(breakdown in cognitive, emotional, or behavioral functioning) within an individual associated with distress or impairment and a response that is not typical or culturally expected". Thus, psychopathology is the scientific study of a mental condition where the individual suffers significant pain and misery, even to the point that they feel as if their very "life-breath" (soul) is being damaged or sucked out of them.
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