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Wikipedia

Mental disorder

It has been suggested that Mental illness denial be merged into this article. (Discuss) Proposed since November 2021.

A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as single episodes. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional, usually a clinical psychologist or psychiatrist.

Mental disorder
Other namesPsychiatric disorder, psychological disorder, mental illness, mental disease, mental breakdown, nervous breakdown, mental health conditions
SpecialtyPsychiatry
SymptomsAgitation, anxiety, depression, mania, paranoia, psychosis
ComplicationsCognitive impairment, social problems, suicide
TypesAnxiety disorders, eating disorders, mood disorders, personality disorders, psychotic disorders, substance use disorders
CausesGenetic and environmental factors
TreatmentPsychotherapy, medications
MedicationAntidepressants, antipsychotics, anxiolytics, mood stabilizers, stimulants
Frequency18% per year (United States)

The causes of mental disorders are often unclear. Theories may incorporate findings from a range of fields. Mental disorders are usually defined by a combination of how a person behaves, feels, perceives, or thinks. This may be associated with particular regions or functions of the brain, often in a social context. A mental disorder is one aspect of mental health. Cultural and religious beliefs, as well as social norms, should be taken into account when making a diagnosis.

Services are based in psychiatric hospitals or in the community, and assessments are carried out by mental health professionals such as psychiatrists, psychologists, psychiatric nurses and clinical social workers, using various methods such as psychometric tests but often relying on observation and questioning. Treatments are provided by various mental health professionals. Psychotherapy and psychiatric medication are two major treatment options. Other treatments include lifestyle changes, social interventions, peer support, and self-help. In a minority of cases, there might be involuntary detention or treatment. Prevention programs have been shown to reduce depression.

In 2019, common mental disorders around the globe include depression, which affects about 264 million, bipolar disorder, which affects about 45 million, dementia, which affects about 50 million, and schizophrenia and other psychoses, which affects about 20 million people. Neurodevelopmental disorders include intellectual disability and autism spectrum disorders which usually arise in infancy or childhood. Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion.

Contents

"Nervous breakdown" redirects here. For other uses, see Nervous breakdown (disambiguation).

The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to classify as a disorder, it generally needs to cause dysfunction. Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind) is not necessarily meant to imply separateness from the brain or body.

According to DSM-IV, a mental disorder is a psychological syndrome or pattern which is associated with distress (e.g. via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however it excludes normal responses such as grief from loss of a loved one and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.

DSM-IV predicates the definition with caveats, stating that, as in the case with many medical terms, mental disorder "lacks a consistent operational definition that covers all situations", noting that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same is true for mental disorders so that sometimes one type of definition is appropriate, and sometimes another, depending on the situation.

In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning." The final draft of ICD-11 contains a very similar definition.

The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder. The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10, and are nearly absent from scientific literature regarding mental illness. Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder, involving symptoms such as anxiety or depression, usually precipitated by external stressors. Many health experts today refer to a nervous breakdown as a mental health crisis.

Nervous illness

Additionally to the concept of mental disorder, some people have argued for a return to the old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says:

About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point.

Edward Shorter, Faculty of Medicine, the University of Toronto

In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown.

David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales

Nerves stand at the core of common mental illness, no matter how much we try to forget them.

Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London

"Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenon called "nervous breakdown".

Richard E. Vatz, co-author of explication of views of Thomas Szasz in "Thomas Szasz: Primary Values and Major Contentions"

There are currently two widely established systems that classify mental disorders:

Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in non-western cultures, for example, the Chinese Classification of Mental Disorders, and other manuals may be used by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual. In general, mental disorders are classified separately from neurological disorders, learning disabilities or intellectual disability.

Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both.

In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms). Common hybrid views argue that the concept of mental disorder is objective even if only a "fuzzy prototype" that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments. Although the diagnostic categories are referred to as 'disorders', they are presented as medical diseases, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview, while others suggest that the differing ideological and practical perspectives need to be better integrated.

The DSM and ICD approach remains under attack both because of the implied causality model and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.

Dimensional models

The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms. A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports the internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia. Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders.

Disorders

There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.

Anxiety disorder

Anxiety disorder: Anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder. Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder and post-traumatic stress disorder.

Mood disorder

Mood 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 (also known as unipolar 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 moods. The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and merge along a dimension or spectrum of mood, is subject to some scientific debate.

Psychotic disorder

Psychotic disorder: Patterns of belief, language use and perception of reality can become dysregulated (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 cutoff criteria.

Personality disorder

Personality disorder: Personality—the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive. Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on a separate axis II in the case of the DSM-IV. A number of different personality disorders are listed, including those sometimes classed as eccentric, such as paranoid, schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant, dependent, or obsessive-compulsive personality disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. The ICD also has a category for enduring personality change after a catastrophic experience or psychiatric illness. 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 personality disorders, similar to personality traits in general, incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring. Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models.[non-primary source needed]

Eating disorder

Eating disorders involve disproportionate concern in matters of food and weight. Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.

Sleep disorder

Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder is insomnia, which is described as difficulty falling and/or staying asleep.

Sexuality related

Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others).

Other

Impulse control disorder: People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, 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.

Substance use disorder: This disorder refers to the use of drugs (legal or illegal, including alcohol) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in the DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped.

Dissociative disorder: People who suffer severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization disorder or dissociative identity disorder (which was previously referred to as multiple personality disorder or "split personality").

Cognitive disorder: These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia).

Developmental disorder: These disorders initially occur in childhood. Some examples include autism spectrum disorder, 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). Popular labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses.

Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder. There are also disorders of how a person perceives their body, such as 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.[non-primary source needed]

Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for.

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.

There are a number of uncommon psychiatric syndromes, which are often named after the person who first described them, such as Capgras syndrome, De Clerambault syndrome, Othello syndrome, Ganser syndrome, Cotard delusion, and Ekbom syndrome, and additional disorders such as the Couvade syndrome and Geschwind syndrome.

Various new types of mental disorder diagnoses 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, gender dysphoria and premenstrual dysphoric disorder.

Course

The onset of psychiatric disorders usually occurs from childhood to early adulthood. Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders and mood disorders emerge later in the mid-teens. Symptoms of schizophrenia typically manifest from late adolescence to early twenties.

The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders may last a brief period of time, while others may be long-term in nature.

All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery is still plausible. The World Health Organization concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century."[non-primary source needed]

A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years.[non-primary source needed]

Disability

Disorder Disability-adjusted life years
Major depressive disorder 65.5 million
Alcohol-use disorder 23.7 million
Schizophrenia 16.8 million
Bipolar disorder 14.4 million
Other drug-use disorders 8.4 million
Panic disorder 7.0 million
Obsessive-compulsive disorder 5.1 million
Primary insomnia 3.6 million
Post-traumatic stress disorder 3.5 million

Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. The degree of ability or disability may vary over time and across different life domains. Furthermore, continued disability has been linked to institutionalization, discrimination and social exclusion as well as to the inherent effects of disorders. Alternatively, functioning may be affected by the stress of having to hide a condition in work or school, etc., by adverse effects of medications or other substances, or by mismatches between illness-related variations and demands for regularity.

It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as disorders can also involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy. In addition, the public perception of the level of disability associated with mental disorders can change.

Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having a severely disabling condition. Disability in this context may or may not involve such things as:

  • Basic activities of daily living. Including looking after the self (health care, grooming, dressing, shopping, cooking etc.) or looking after accommodation (chores, DIY tasks, etc.)
  • Interpersonal relationships. Including communication skills, ability to form relationships and sustain them, ability to leave the home or mix in crowds or particular settings
  • Occupational functioning. Ability to acquire an employment and hold it, cognitive and social skills required for the job, dealing with workplace culture, or studying as a student.

In terms of total disability-adjusted life years (DALYs), which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability, mental disorders rank amongst the most disabling conditions. Unipolar (also known as Major) depressive disorder is the third leading cause of disability worldwide, of any condition mental or physical, accounting for 65.5 million years lost. The first systematic description of global disability arising in youth, in 2011, found that among 10- to 24-year-olds nearly half of all disability (current and as estimated to continue) was due to mental and neurological conditions, including substance use disorders and conditions involving self-harm. Second to this were accidental injuries (mainly traffic collisions) accounting for 12 percent of disability, followed by communicable diseases at 10 percent. The disorders associated with most disabilities in high-income countries were unipolar major depression (20%) and alcohol use disorder (11%). In the eastern Mediterranean region, it was unipolar major depression (12%) and schizophrenia (7%), and in Africa it was unipolar major depression (7%) and bipolar disorder (5%).

Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.

The predominant view as of 2018 is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders. Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.

Genetics

Main article: Psychiatric genetics

A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder and anxiety). Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia). Although researchers have been looking for decades for clear linkages between genetics and mental disorders, that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments.

Statistical research looking at eleven disorders found widespread assortative mating between people with mental illness. That means that individuals with one of these disorders were two to three times more likely than the general population to have a partner with a mental disorder. Sometimes people seemed to have preferred partners with the same mental illness. Thus, people with schizophrenia or ADHD are seven times more likely to have affected partners with the same disorder. This is even more pronounced for people with Autism spectrum disorders who are 10 times more likely to have a spouse with the same disorder.

Environment

The prevalence of mental illness is higher in more economically unequal countries

During the prenatal stage, factors like unwanted pregnancy, lack of adaptation to pregnancy or substance use during pregnancy increases the risk of developing a mental disorder. Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness. Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment.

Social influences have also been found to be important, including abuse, neglect, bullying, social stress, traumatic events, and other negative or overwhelming life experiences. 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. The specific risks and pathways to particular disorders are less clear, however.

Nutrition also plays a role in mental disorders.

In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, recreational use of drugs, and urbanicity.

In anxiety, risk factors may include parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, and child abuse (emotional, physical and sexual). Adults with imbalance work to life are at higher risk for developing anxiety.

For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.

Drug use

Mental disorders are associated with drug use including: cannabis, alcohol and caffeine, use of which appears to promote anxiety. For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines. There has been debate regarding the relationship between usage of cannabis and bipolar disorder. Cannabis has also been associated with depression. Adolescents are at increased risk for tobacco, alcohol and drug use; Peer pressure is the main reason why adolescents start using substances. At this age, the use of substances could be detrimental to the development of the brain and place them at higher risk of developing a mental disorder.

Chronic disease

People living with chronic conditions like HIV and diabetes are at higher risk of developing a mental disorder. People living with diabetes experience significant stress from biological impact of the disease, which places them at risk for developing anxiety and depression. Diabetic patients also have to deal with emotional stress trying to manage the disease. Conditions like heart disease, stroke, respiratory conditions, cancer, and arthritis increase the risk of developing a mental disorder when compared to the general population.

Personality traits

Risk factors for mental illness include a propensity for high neuroticism or "emotional instability". In anxiety, risk factors may include temperament and attitudes (e.g. pessimism).

Causal models

Mental disorders can arise from multiple sources, and in many cases there is no single accepted or consistent cause currently established. An eclectic or pluralistic mix of models may be used to explain particular disorders. The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial model which incorporates biological, psychological and social factors, although this may not always be applied in practice.

Biological psychiatry follows a biomedical model where many mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience. A common assumption is that disorders may have resulted from genetic and developmental vulnerabilities, exposed by stress in life (for example in a diathesis–stress model), although there are various views on what causes differences between individuals. Some types of mental disorders may be viewed as primarily neurodevelopmental disorders.

Evolutionary psychology may be used as an overall explanatory theory, while attachment theory is another kind of evolutionary-psychological approach sometimes applied in the context of mental disorders. Psychoanalytic theories have continued to evolve alongside and cognitive-behavioral and systemic-family approaches. A distinction is sometimes made between a "medical model" or a "social model" of disorder and disability.

Psychiatrists seek to provide a medical diagnosis of individuals by an assessment of symptoms, signs and impairment associated with particular types of mental disorder. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic categories to their clinical formulation of a client's difficulties and circumstances. The majority of mental health problems are, at least initially, assessed and treated by family physicians (in the UK general practitioners) during consultations, who may refer a patient on for more specialist diagnosis in acute or chronic cases.

Routine diagnostic practice in mental health services typically involves an interview known as a mental status examination, where evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of other professionals, relatives, or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in rare specialist cases neuroimaging tests may be requested, but such methods are more commonly found in research studies than routine clinical practice.

Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations. It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice. In addition, comorbidity is very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties only some of which meet the criteria for being diagnosed. There may be specific problems with accurate diagnosis in developing countries.

More structured approaches are being increasingly used to measure levels of mental illness.

  • HoNOS is the most widely used measure in English mental health services, being used by at least 61 trusts. In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity. Research has been supportive of HoNOS, although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment.

Criticism

This section relies too much on references to primary sources. Please improve this section by adding secondary or tertiary sources.(July 2021) ()

Since the 1980s, Paula Caplan has been concerned about the subjectivity of psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label." Caplan says because psychiatric diagnosis is unregulated, doctors are not required to spend much time interviewing patients or to seek a second opinion. The Diagnostic and Statistical Manual of Mental Disorders can lead a psychiatrist to focus on narrow checklists of symptoms, with little consideration of what is actually causing the person's problems. So, according to Caplan, getting a psychiatric diagnosis and label often stands in the way of recovery.[unreliable medical source]

In 2013, psychiatrist Allen Frances wrote a paper entitled "The New Crisis of Confidence in Psychiatric Diagnosis", which said that "psychiatric diagnosis... still relies exclusively on fallible subjective judgments rather than objective biological tests." Frances was also concerned about "unpredictable overdiagnosis." For many years, marginalized psychiatrists (such as Peter Breggin, Thomas Szasz) and outside critics (such as Stuart A. Kirk) have "been accusing psychiatry of engaging in the systematic medicalization of normality." More recently these concerns have come from insiders who have worked for and promoted the American Psychiatric Association (e.g., Robert Spitzer, Allen Frances). A 2002 editorial in the British Medical Journal warned of inappropriate medicalization leading to disease mongering, where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden the market for medications.

Gary Greenberg, a psychoanalyst, in his book "the Book of Woe", argues that mental illness is really about suffering and how the DSM creates diagnostic labels to categorize people's suffering. Indeed, the psychiatrist Thomas Szasz, in his book "the Medicalization of Everyday Life", also argues that what is psychiatric illness, is not always biological in nature (i.e. social problems, poverty, etc.), and may even be a part of the human condition.

The 2004 WHO report "Prevention of Mental Disorders" stated that "Prevention of these disorders is obviously one of the most effective ways to reduce the [disease] burden." The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions." A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure". In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area.

Parenting may affect the child's mental health, and evidence suggests that helping parents to be more effective with their children can address mental health needs.

Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials.

"Haus Tornow am See" (former manor house), Germany from 1912 is today separated into a special education school and a hotel with integrated work/job- and rehabilitation-training for people with mental disorders

Treatment and support for mental disorders are provided in psychiatric hospitals, clinics or a range of community mental health services. In some countries services are increasingly based on a recovery approach, intended to support individual's personal journey to gain the kind of life they want.

There is a range of different types of treatment and what is most suitable depends on the disorder and the individual. Many things have been found to help at least some people, and a placebo effect may play a role in any intervention or medication. In a minority of cases, individuals may be treated against their will, which can cause particular difficulties depending on how it is carried out and perceived. Compulsory treatment while in the community versus non-compulsory treatment does not appear to make much of a difference except by maybe decreasing victimization.

Lifestyle

Lifestyle strategies, including dietary changes, exercise and quitting smoking may be of benefit.

Therapy

There is also a wide range of psychotherapists (including family therapy), counselors, and public health professionals. In addition, there are peer support roles where personal experience of similar issues is the primary source of expertise.

A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Other psychotherapies include dialectic behavioral therapy (DBT) and interpersonal psychotherapy (IPT). Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual.

Some psychotherapies are based on a humanistic approach. There are many specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Much may depend on the therapeutic relationship, and there may be problems with trust, confidentiality and engagement.

Medication

A major option for many mental disorders is psychiatric medication and there are several main groups. Antidepressants are used for the treatment of clinical depression, as well as often for anxiety and a range of other disorders. Anxiolytics (including sedatives) are used for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder. Antipsychotics are used for psychotic disorders, notably for positive symptoms in schizophrenia, and also increasingly for a range of other disorders. Stimulants are commonly used, notably for ADHD.

Despite the different conventional names of the drug groups, there may be considerable overlap in the disorders for which they are actually indicated, and there may also be off-label use of medications. There can be problems with adverse effects of medication and adherence to them, and there is also criticism of pharmaceutical marketing and professional conflicts of interest. However, these medications in combination with non-pharmacological methods, such as cognitive-behavioral therapy (CBT) are seen to be most effective in treating mental disorders.

Other

Electroconvulsive therapy (ECT) is sometimes used in severe cases when other interventions for severe intractable depression have failed. ECT is usually indicated for treatment resistant depression, severe vegetative symptoms, psychotic depression, intense suicidal ideation, depression during pregnancy, and catonia. Psychosurgery is considered experimental but is advocated by some neurologists in certain rare cases.

Counseling (professional) and co-counseling (between peers) may be used. Psychoeducation programs may provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including music therapy, art therapy or drama therapy. Lifestyle adjustments and supportive measures are often used, including peer support, self-help groups for mental health and supported housing or supported employment (including social firms). Some advocate dietary supplements.

Reasonable accommodations (adjustments and supports) might be put in place to help an individual cope and succeed in environments despite potential disability related to mental health problems. This could include an emotional support animal or specifically trained psychiatric service dog. As of 2019 cannabis is specifically not recommended as a treatment.

Deaths from mental and behavioral disorders per million persons in 2012
0–6
7–9
10–15
16–24
25–31
32–39
40–53
54–70
71–99
100–356
Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2004.
<2,200
2,200–2,400
2,400–2,600
2,600–2,800
2,800–3,000
3,000–3,200
3,200–3,400
3,400–3,600
3,600–3,800
3,800–4,000
4,000–4,200
>4,200

Mental disorders are common. Worldwide, more than one in three people in most countries report sufficient criteria for at least one at some point in their life. In the United States, 46% qualify for a mental illness at some point. An ongoing survey indicates that anxiety disorders are the most common in all but one country, followed by mood disorders in all but two countries, while substance disorders and impulse-control disorders were consistently less prevalent. Rates varied by region.

A review of anxiety disorder surveys in different countries found average lifetime prevalence estimates of 16.6%, with women having higher rates on average. A review of mood disorder surveys in different countries found lifetime rates of 6.7% for major depressive disorder (higher in some studies, and in women) and 0.8% for Bipolar I disorder.

In the United States the frequency of disorder is: anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder (24.8%) or substance use disorder (14.6%).

A 2004 cross-Europe study found that approximately one in four people reported meeting criteria at some point in their life for at least one of the DSM-IV disorders assessed, which included mood disorders (13.9%), anxiety disorders (13.6%), or alcohol disorder (5.2%). Approximately one in ten met the criteria within a 12-month period. Women and younger people of either gender showed more cases of the disorder. A 2005 review of surveys in 16 European countries found that 27% of adult Europeans are affected by at least one mental disorder in a 12-month period.

An international review of studies on the prevalence of schizophrenia found an average (median) figure of 0.4% for lifetime prevalence; it was consistently lower in poorer countries.

Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but one broad Norwegian survey found a five-year prevalence of almost 1 in 7 (13.4%). Rates for specific disorders ranged from 0.8% to 2.8%, differing across countries, and by gender, educational level and other factors. A US survey that incidentally screened for personality disorder found a rate of 14.79%.

Approximately 7% of a preschool pediatric sample were given a psychiatric diagnosis in one clinical study, and approximately 10% of 1- and 2-year-olds receiving developmental screening have been assessed as having significant emotional/behavioral problems based on parent and pediatrician reports.

While rates of psychological disorders are often the same for men and women, women tend to have a higher rate of depression. Each year 73 million women are affected by major depression, and suicide is ranked 7th as the cause of death for women between the ages of 20–59. Depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men.

Ancient civilizations

Ancient civilizations described and treated a number of mental disorders. Mental illnesses were well known in ancient Mesopotamia, where diseases and mental disorders were believed to be caused by specific deities. Because hands symbolized control over a person, mental illnesses were known as "hands" of certain deities. One psychological illness was known as Qāt Ištar, meaning "Hand of Ishtar". Others were known as "Hand of Shamash", "Hand of the Ghost", and "Hand of the God". Descriptions of these illnesses, however, are so vague that it is usually impossible to determine which illnesses they correspond to in modern terminology. Mesopotamian doctors kept detailed record of their patients' hallucinations and assigned spiritual meanings to them. The royal family of Elam was notorious for its members frequently suffering from insanity. The Greeks coined terms for melancholy, hysteria and phobia and developed the humorism theory. Mental disorders were described, and treatments developed, in Persia, Arabia and in the medieval Islamic world.

Europe

Middle Ages

Conceptions of madness in the Middle Ages in Christian Europe were a mixture of the divine, diabolical, magical and humoral, and transcendental. In the early modern period, some people with mental disorders may have been victims of the witch-hunts. While not every witch and sorcerer accused were mentally ill, all mentally ill were considered to be witches or sorcerers. Many terms for mental disorders that found their way into everyday use first became popular in the 16th and 17th centuries.

Eighteenth century

Eight patients representing mental diagnoses as of the 19th century at the Salpêtrière, Paris.

By the end of the 17th century and into the Enlightenment, madness was increasingly seen as an organic physical phenomenon with no connection to the soul or moral responsibility. Asylum care was often harsh and treated people like wild animals, but towards the end of the 18th century a moral treatment movement gradually developed. Clear descriptions of some syndromes may be rare before the 19th century.

Nineteenth century

Industrialization and population growth led to a massive expansion of the number and size of insane asylums in every Western country in the 19th century. Numerous different classification schemes and diagnostic terms were developed by different authorities, and the term psychiatry was coined (1808), though medical superintendents were still known as alienists.

Twentieth century

A patient in a strait-jacket and barrel contraption, 1908

The turn of the 20th century saw the development of psychoanalysis, which would later come to the fore, along with Kraepelin's classification scheme. Asylum "inmates" were increasingly referred to as "patients", and asylums were renamed as hospitals.

Europe and the United States

Early in the 20th century in the United States, a mental hygiene movement developed, aiming to prevent mental disorders. Clinical psychology and social work developed as professions. World War I saw a massive increase of conditions that came to be termed "shell shock".

World War II saw the development in the U.S. of a new psychiatric manual for categorizing mental disorders, which along with existing systems for collecting census and hospital statistics led to the first Diagnostic and Statistical Manual of Mental Disorders. The International Classification of Diseases (ICD) also developed a section on mental disorders. The term stress, having emerged from endocrinology work in the 1930s, was increasingly applied to mental disorders.

Electroconvulsive therapy, insulin shock therapy, lobotomies and the neuroleptic chlorpromazine came to be used by mid-century. In the 1960s there were many challenges to the concept of mental illness itself. These challenges came from psychiatrists like Thomas Szasz who argued that mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman who said that mental illness was merely another example of how society labels and controls non-conformists; from behavioral psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. A study published in Science by Rosenhan received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis.

Deinstitutionalization gradually occurred in the West, with isolated psychiatric hospitals being closed down in favor of community mental health services. A consumer/survivor movement gained momentum. Other kinds of psychiatric medication gradually came into use, such as "psychic energizers" (later antidepressants) and lithium. Benzodiazepines gained widespread use in the 1970s for anxiety and depression, until dependency problems curtailed their popularity.

Advances in neuroscience, genetics, and psychology led to new research agendas. Cognitive behavioral therapy and other psychotherapies developed. The DSM and then ICD adopted new criteria-based classifications, and the number of "official" diagnoses saw a large expansion. Through the 1990s, new SSRI-type antidepressants became some of the most widely prescribed drugs in the world, as later did antipsychotics. Also during the 1990s, a recovery approach developed.

Different societies or cultures, even different individuals in a subculture, can disagree as to what constitutes optimal versus pathological biological and psychological functioning. Research has demonstrated that cultures vary in the relative importance placed on, for example, happiness, autonomy, or social relationships for pleasure. Likewise, the fact that a behavior pattern is valued, accepted, encouraged, or even statistically normative in a culture does not necessarily mean that it is conducive to optimal psychological functioning.

People in all cultures find some behaviors bizarre or even incomprehensible. But just what they feel is bizarre or incomprehensible is ambiguous and subjective. These differences in determination can become highly contentious. The process by which conditions and difficulties come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals, is known as medicalization or pathologization.

Religion

Religious, spiritual, or transpersonal experiences and beliefs meet many criteria of delusional or psychotic disorders. A belief or experience can sometimes be shown to produce distress or disability—the ordinary standard for judging mental disorders. There is a link between religion and schizophrenia, a complex mental disorder characterized by a difficulty in recognizing reality, regulating emotional responses, and thinking in a clear and logical manner. Those with schizophrenia commonly report some type of religious delusion, and religion itself may be a trigger for schizophrenia.

Movements

Giorgio Antonucci
Thomas Szasz

Controversy has often surrounded psychiatry, and the term anti-psychiatry was coined by the psychiatrist David Cooper in 1967. The anti-psychiatry message is that psychiatric treatments are ultimately more damaging than helpful to patients, and psychiatry's history involves what may now be seen as dangerous treatments. Electroconvulsive therapy was one of these, which was used widely between the 1930s and 1960s. Lobotomy was another practice that was ultimately seen as too invasive and brutal. Diazepam and other sedatives were sometimes over-prescribed, which led to an epidemic of dependence. There was also concern about the large increase in prescribing psychiatric drugs for children. Some charismatic psychiatrists came to personify the movement against psychiatry. The most influential of these was R.D. Laing who wrote a series of best-selling books, including The Divided Self. Thomas Szasz wrote The Myth of Mental Illness. Some ex-patient groups have become militantly anti-psychiatric, often referring to themselves as survivors. Giorgio Antonucci has questioned the basis of psychiatry through his work on the dismantling of two psychiatric hospitals (in the city of Imola), carried out from 1973 to 1996.

The consumer/survivor movement (also known as user/survivor movement) is made up of individuals (and organizations representing them) who are clients of mental health services or who consider themselves survivors of psychiatric interventions. Activists campaign for improved mental health services and for more involvement and empowerment within mental health services, policies and wider society. Patient advocacy organizations have expanded with increasing deinstitutionalization in developed countries, working to challenge the stereotypes, stigma and exclusion associated with psychiatric conditions. There is also a carers rights movement of people who help and support people with mental health conditions, who may be relatives, and who often work in difficult and time-consuming circumstances with little acknowledgement and without pay. An anti-psychiatry movement fundamentally challenges mainstream psychiatric theory and practice, including in some cases asserting that psychiatric concepts and diagnoses of 'mental illness' are neither real nor useful.

Alternatively, a movement for global mental health has emerged, defined as 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide'.

Cultural bias

Current diagnostic guidelines, namely the DSM and to some extent the ICD, have been criticized as having a fundamentally Euro-American outlook. Opponents argue that even when diagnostic criteria are used across different cultures, it does not mean that the underlying constructs have validity within those cultures, as even reliable application can prove only consistency, not legitimacy. Advocating a more culturally sensitive approach, critics such as Carl Bell and Marcello Maviglia contend that the cultural and ethnic diversity of individuals is often discounted by researchers and service providers.

Cross-cultural psychiatrist Arthur Kleinman contends that the Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV. Disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard psychiatric diagnoses are given no cultural qualification whatsoever, revealing to Kleinman an underlying assumption that Western cultural phenomena are universal. Kleinman's negative view towards the culture-bound syndrome is largely shared by other cross-cultural critics. Common responses included both disappointment over the large number of documented non-Western mental disorders still left out and frustration that even those included are often misinterpreted or misrepresented.

Many mainstream psychiatrists are dissatisfied with the new culture-bound diagnoses, although for partly different reasons. Robert Spitzer, a lead architect of the DSM-III, has argued that adding cultural formulations was an attempt to appease cultural critics, and has stated that they lack any scientific rationale or support. Spitzer also posits that the new culture-bound diagnoses are rarely used, maintaining that the standard diagnoses apply regardless of the culture involved. In general, mainstream psychiatric opinion remains that if a diagnostic category is valid, cross-cultural factors are either irrelevant or are significant only to specific symptom presentations.

Clinical conceptions of mental illness also overlap with personal and cultural values in the domain of morality, so much so that it is sometimes argued that separating the two is impossible without fundamentally redefining the essence of being a particular person in a society. In clinical psychiatry, persistent distress and disability indicate an internal disorder requiring treatment; but in another context, that same distress and disability can be seen as an indicator of emotional struggle and the need to address social and structural problems. This dichotomy has led some academics and clinicians to advocate a postmodernist conceptualization of mental distress and well-being.

Such approaches, along with cross-cultural and "heretical" psychologies centered on alternative cultural and ethnic and race-based identities and experiences, stand in contrast to the mainstream psychiatric community's alleged avoidance of any explicit involvement with either morality or culture. In many countries there are attempts to challenge perceived prejudice against minority groups, including alleged institutional racism within psychiatric services. There are also ongoing attempts to improve professional cross cultural sensitivity.

Laws and policies

Three-quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as involuntary commitment) is a controversial topic. It can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social, and other reasons; yet it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when they may be unable to decide in their own interests. Because of this it is a concern of medical ethics.

All human rights oriented mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often used grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-oriented laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body. The individual should also have personal access to independent advocacy.

For involuntary treatment to be administered (by force if necessary), it should be shown that an individual lacks the mental capacity for informed consent (i.e. to understand treatment information and its implications, and therefore be able to make an informed choice to either accept or refuse). Legal challenges in some areas have resulted in supreme court decisions that a person does not have to agree with a psychiatrist's characterization of the issues as constituting an "illness", nor agree with a psychiatrist's conviction in medication, but only recognize the issues and the information about treatment options.

Proxy consent (also known as surrogate or substituted decision-making) may be transferred to a personal representative, a family member, or a legally appointed guardian. Moreover, patients may be able to make, when they are considered well, an advance directive stipulating how they wish to be treated should they be deemed to lack mental capacity in the future. The right to supported decision-making, where a person is helped to understand and choose treatment options before they can be declared to lack capacity, may also be included in the legislation. There should at the very least be shared decision-making as far as possible. Involuntary treatment laws are increasingly extended to those living in the community, for example outpatient commitment laws (known by different names) are used in New Zealand, Australia, the United Kingdom, and most of the United States.

The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated. In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006, the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities.

The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term. The insanity defense may be used in a legal trial (known as the mental disorder defence in some countries).

Perception and discrimination

Stigma

The social stigma associated with mental disorders is a widespread problem. The US Surgeon General stated in 1999 that: "Powerful and pervasive, stigma prevents people from acknowledging their own mental health problems, much less disclosing them to others." In the United States, racial and ethnic minorities are more likely to experience mental health disorders often due to low socioeconomic status, and discrimination. In Taiwan, those with mental disorders are subject to general public's misperception that the root causes of the mental disorders are "over-thinking", "having a lot of time and nothing better to do", "stagnant", "not serious in life", "not paying enough attention to the real life affairs", "mentally weak", "refusing to be resilient", "turning back to perfectionistic strivings", "not bravery" and so forth.

Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness. An Australian study found that having a mental illness is a bigger barrier to employment than a physical disability.[better source needed] The mentally ill are stigmatized in Chinese society and can not legally marry.

Efforts are being undertaken worldwide to eliminate the stigma of mental illness, although the methods and outcomes used have sometimes been criticized.

Media and general public

Media coverage of mental illness comprises predominantly negative and pejorative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or human rights issues. Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.

In the United States, the Carter Center has created fellowships for journalists in South Africa, the U.S., and Romania, to enable reporters to research and write stories on mental health topics. Former US First Lady Rosalynn Carter began the fellowships not only to train reporters in how to sensitively and accurately discuss mental health and mental illness, but also to increase the number of stories on these topics in the news media. There is also a World Mental Health Day, which in the US and Canada falls within a Mental Illness Awareness Week.

The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill. A US national survey found that a higher percentage of people rate individuals described as displaying the characteristics of a mental disorder as "likely to do something violent to others", compared to the percentage of people who are rating individuals described as being troubled.

Recent depictions in media have included leading characters successfully living with and managing a mental illness, including in bipolar disorder in Homeland (2011) and posttraumatic stress disorder in Iron Man 3 (2013).[original research?]

Violence

Despite public or media opinion, national studies have indicated that severe mental illness does not independently predict future violent behavior, on average, and is not a leading cause of violence in society. There is a statistical association with various factors that do relate to violence (in anyone), such as substance use and various personal, social, and economic factors. A 2015 review found that in the United States, about 4% of violence is attributable to people diagnosed with mental illness, and a 2014 study found that 7.5% of crimes committed by mentally ill people were directly related to the symptoms of their mental illness. The majority of people with serious mental illness are never violent.

In fact, findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victims rather than the perpetrators of violence. In a study of individuals diagnosed with "severe mental illness" living in a US inner-city area, a quarter were found to have been victims of at least one violent crime over the course of a year, a proportion eleven times higher than the inner-city average, and higher in every category of crime including violent assaults and theft. People with a diagnosis may find it more difficult to secure prosecutions, however, due in part to prejudice and being seen as less credible.

However, there are some specific diagnoses, such as childhood conduct disorder or adult antisocial personality disorder or psychopathy, which are defined by, or are inherently associated with, conduct problems and violence. There are conflicting findings about the extent to which certain specific symptoms, notably some kinds of psychosis (hallucinations or delusions) that can occur in disorders such as schizophrenia, delusional disorder or mood disorder, are linked to an increased risk of serious violence on average. The mediating factors of violent acts, however, are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, male, of lower socioeconomic status and, in particular, substance use (including alcohol use) to which some people may be particularly vulnerable.

High-profile cases have led to fears that serious crimes, such as homicide, have increased due to deinstitutionalization, but the evidence does not support this conclusion. Violence that does occur in relation to mental disorder (against the mentally ill or by the mentally ill) typically occurs in the context of complex social interactions, often in a family setting rather than between strangers. It is also an issue in health care settings and the wider community.

Main article: Mental health

The recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition, assessment, and classification, although standard guideline criteria are widely used. In many cases, there appears to be a continuum between mental health and mental illness, making diagnosis complex.: 39 According to the World Health Organization (WHO), over a third of people in most countries report problems at some time in their life which meet the criteria for diagnosis of one or more of the common types of mental disorder. Corey M Keyes has created a two continua model of mental illness and health which holds that both are related, but distinct dimensions: one continuum indicates the presence or absence of mental health, the other the presence or absence of mental illness. For example, people with optimal mental health can also have a mental illness, and people who have no mental illness can also have poor mental health.

Psychopathology in non-human primates has been studied since the mid-20th century. Over 20 behavioral patterns in captive chimpanzees have been documented as (statistically) abnormal for frequency, severity or oddness—some of which have also been observed in the wild. Captive great apes show gross behavioral abnormalities such as stereotypy of movements, self-mutilation, disturbed emotional reactions (mainly fear or aggression) towards companions, lack of species-typical communications, and generalized learned helplessness. In some cases such behaviors are hypothesized to be equivalent to symptoms associated with psychiatric disorders in humans such as depression, anxiety disorders, eating disorders and post-traumatic stress disorder. Concepts of antisocial, borderline and schizoid personality disorders have also been applied to non-human great apes.

The risk of anthropomorphism is often raised concerning such comparisons, and assessment of non-human animals cannot incorporate evidence from linguistic communication. However, available evidence may range from nonverbal behaviors—including physiological responses and homologous facial displays and acoustic utterances—to neurochemical studies. It is pointed out that human psychiatric classification is often based on statistical description and judgment of behaviors (especially when speech or language is impaired) and that the use of verbal self-report is itself problematic and unreliable.

Psychopathology has generally been traced, at least in captivity, to adverse rearing conditions such as early separation of infants from mothers; early sensory deprivation; and extended periods of social isolation. Studies have also indicated individual variation in temperament, such as sociability or impulsiveness. Particular causes of problems in captivity have included integration of strangers into existing groups and a lack of individual space, in which context some pathological behaviors have also been seen as coping mechanisms. Remedial interventions have included careful individually tailored re-socialization programs, behavior therapy, environment enrichment, and on rare occasions psychiatric drugs. Socialization has been found to work 90% of the time in disturbed chimpanzees, although restoration of functional sexuality and caregiving is often not achieved.

Laboratory researchers sometimes try to develop animal models of human mental disorders, including by inducing or treating symptoms in animals through genetic, neurological, chemical or behavioral manipulation, but this has been criticized on empirical grounds and opposed on animal rights grounds.

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Mental disorder
Mental disorder Language Watch Edit 160 160 Redirected from Stigma against mental disorders It has been suggested that Mental illness denial be merged into this article Discuss Proposed since November 2021 A mental disorder also called a mental illness 3 or psychiatric disorder is a behavioral or mental pattern that causes significant distress or impairment of personal functioning 4 Such features may be persistent relapsing and remitting or occur as single episodes Many disorders have been described with signs and symptoms that vary widely between specific disorders 5 6 Such disorders may be diagnosed by a mental health professional usually a clinical psychologist or psychiatrist Mental disorderOther namesPsychiatric disorder psychological disorder mental illness mental disease mental breakdown nervous breakdown mental health conditions 1 SpecialtyPsychiatrySymptomsAgitation anxiety depression mania paranoia psychosisComplicationsCognitive impairment social problems suicideTypesAnxiety disorders eating disorders mood disorders personality disorders psychotic disorders substance use disordersCausesGenetic and environmental factorsTreatmentPsychotherapy medicationsMedicationAntidepressants antipsychotics anxiolytics mood stabilizers stimulantsFrequency18 per year United States 2 The causes of mental disorders are often unclear Theories may incorporate findings from a range of fields Mental disorders are usually defined by a combination of how a person behaves feels perceives or thinks 7 This may be associated with particular regions or functions of the brain often in a social context A mental disorder is one aspect of mental health Cultural and religious beliefs as well as social norms should be taken into account when making a diagnosis 8 Services are based in psychiatric hospitals or in the community and assessments are carried out by mental health professionals such as psychiatrists psychologists psychiatric nurses and clinical social workers using various methods such as psychometric tests but often relying on observation and questioning Treatments are provided by various mental health professionals Psychotherapy and psychiatric medication are two major treatment options Other treatments include lifestyle changes social interventions peer support and self help In a minority of cases there might be involuntary detention or treatment Prevention programs have been shown to reduce depression 7 9 In 2019 common mental disorders around the globe include depression which affects about 264 million bipolar disorder which affects about 45 million dementia which affects about 50 million and schizophrenia and other psychoses which affects about 20 million people 10 Neurodevelopmental disorders include intellectual disability and autism spectrum disorders which usually arise in infancy or childhood 11 10 Stigma and discrimination can add to the suffering and disability associated with mental disorders leading to various social movements attempting to increase understanding and challenge social exclusion Contents 1 Definition 1 1 Nervous illness 2 Classifications 2 1 Dimensional models 2 2 Disorders 2 2 1 Anxiety disorder 2 2 2 Mood disorder 2 2 3 Psychotic disorder 2 2 4 Personality disorder 2 2 5 Eating disorder 2 2 6 Sleep disorder 2 2 7 Sexuality related 2 2 8 Other 3 Signs and symptoms 3 1 Course 3 2 Disability 4 Risk factors 4 1 Genetics 4 2 Environment 4 3 Drug use 4 4 Chronic disease 4 5 Personality traits 4 6 Causal models 5 Diagnosis 5 1 Criticism 6 Prevention 7 Management 7 1 Lifestyle 7 2 Therapy 7 3 Medication 7 4 Other 8 Epidemiology 9 History 9 1 Ancient civilizations 9 2 Europe 9 2 1 Middle Ages 9 2 2 Eighteenth century 9 2 3 Nineteenth century 9 2 4 Twentieth century 9 3 Europe and the United States 10 Society and culture 10 1 Religion 10 2 Movements 10 3 Cultural bias 10 4 Laws and policies 10 5 Perception and discrimination 10 5 1 Stigma 10 5 2 Media and general public 10 5 3 Violence 11 Mental health 12 Other animals 13 See also 14 Notes 15 Further reading 16 External linksDefinition Nervous breakdown redirects here For other uses see Nervous breakdown disambiguation The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed For a mental state to classify as a disorder it generally needs to cause dysfunction 12 Most international clinical documents use the term mental disorder while illness is also common It has been noted that using the term mental i e of the mind is not necessarily meant to imply separateness from the brain or body According to DSM IV a mental disorder is a psychological syndrome or pattern which is associated with distress e g via a painful symptom disability impairment in one or more important areas of functioning increased risk of death or causes a significant loss of autonomy however it excludes normal responses such as grief from loss of a loved one and also excludes deviant behavior for political religious or societal reasons not arising from a dysfunction in the individual 13 14 DSM IV predicates the definition with caveats stating that as in the case with many medical terms mental disorder lacks a consistent operational definition that covers all situations noting that different levels of abstraction can be used for medical definitions including pathology symptomology deviance from a normal range or etiology and that the same is true for mental disorders so that sometimes one type of definition is appropriate and sometimes another depending on the situation 15 In 2013 the American Psychiatric Association APA redefined mental disorders in the DSM 5 as a syndrome characterized by clinically significant disturbance in an individual s cognition emotion regulation or behavior that reflects a dysfunction in the psychological biological or developmental processes underlying mental functioning 16 The final draft of ICD 11 contains a very similar definition 17 The terms mental breakdown or nervous breakdown may be used by the general population to mean a mental disorder 18 The terms nervous breakdown and mental breakdown have not been formally defined through a medical diagnostic system such as the DSM 5 or ICD 10 and are nearly absent from scientific literature regarding mental illness 19 20 Although nervous breakdown is not rigorously defined surveys of laypersons suggest that the term refers to a specific acute time limited reactive disorder involving symptoms such as anxiety or depression usually precipitated by external stressors 19 Many health experts today refer to a nervous breakdown as a mental health crisis 21 Nervous illness Additionally to the concept of mental disorder some people have argued for a return to the old fashioned concept of nervous illness In How Everyone Became Depressed The Rise and Fall of the Nervous Breakdown 2013 Edward Shorter a professor of psychiatry and the history of medicine says About half of them are depressed Or at least that is the diagnosis that they got when they were put on antidepressants They go to work but they are unhappy and uncomfortable they are somewhat anxious they are tired they have various physical pains and they tend to obsess about the whole business There is a term for what they have and it is a good old fashioned term that has gone out of use They have nerves or a nervous illness It is an illness not just of mind or brain but a disorder of the entire body We have a package here of five symptoms mild depression some anxiety fatigue somatic pains and obsessive thinking We have had nervous illness for centuries When you are too nervous to function it is a nervous breakdown But that term has vanished from medicine although not from the way we speak The nervous patients of yesteryear are the depressives of today That is the bad news There is a deeper illness that drives depression and the symptoms of mood We can call this deeper illness something else or invent a neologism but we need to get the discussion off depression and onto this deeper disorder in the brain and body That is the point Edward Shorter Faculty of Medicine the University of Toronto 22 In eliminating the nervous breakdown psychiatry has come close to having its own nervous breakdown David Healy MD FRCPsych Professor of Psychiatry University of Cardiff Wales 23 Nerves stand at the core of common mental illness no matter how much we try to forget them Peter J Tyrer FMedSci Professor of Community Psychiatry Imperial College London 24 Nervous breakdown is a pseudo medical term to describe a wealth of stress related feelings and they are often made worse by the belief that there is a real phenomenon called nervous breakdown Richard E Vatz co author of explication of views of Thomas Szasz in Thomas Szasz Primary Values and Major Contentions ClassificationsMain article Classification of mental disorders There are currently two widely established systems that classify mental disorders ICD 10 Chapter V Mental and behavioural disorders since 1949 part of the International Classification of Diseases produced by the WHO the Diagnostic and Statistical Manual of Mental Disorders DSM 5 produced by the APA since 1952 Both of these list categories of disorder and provide standardized criteria for diagnosis They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable although significant differences remain Other classification schemes may be used in non western cultures for example the Chinese Classification of Mental Disorders and other manuals may be used by those of alternative theoretical persuasions such as the Psychodynamic Diagnostic Manual In general mental disorders are classified separately from neurological disorders learning disabilities or intellectual disability Unlike the DSM and ICD some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal There is significant scientific debate about the relative merits of categorical versus such non categorical or hybrid schemes also known as continuum or dimensional models A spectrum approach may incorporate elements of both In the scientific and academic literature on the definition or classification of mental disorder one extreme argues that it is entirely a matter of value judgements including of what is normal while another proposes that it is or could be entirely objective and scientific including by reference to statistical norms 25 Common hybrid views argue that the concept of mental disorder is objective even if only a fuzzy prototype that can never be precisely defined or conversely that the concept always involves a mixture of scientific facts and subjective value judgments 26 Although the diagnostic categories are referred to as disorders they are presented as medical diseases but are not validated in the same way as most medical diagnoses Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview while others suggest that the differing ideological and practical perspectives need to be better integrated 27 28 The DSM and ICD approach remains under attack both because of the implied causality model 29 and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years 30 Dimensional models The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models Studying comorbidity between disorders have demonstrated two latent unobserved factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes These two dimensions reflect a distinction between internalizing disorders such as mood or anxiety symptoms and externalizing disorders such as behavioral or substance use symptoms 31 A single general factor of psychopathology similar to the g factor for intelligence has been empirically supported The p factor model supports the internalizing externalizing distinction but also supports the formation of a third dimension of thought disorders such as schizophrenia 32 Biological evidence also supports the validity of the internalizing externalizing structure of mental disorders with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders 33 34 35 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 36 37 38 39 Anxiety disorder Anxiety disorder Anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder 37 Commonly recognized categories include specific phobias generalized anxiety disorder social anxiety disorder panic disorder agoraphobia obsessive compulsive disorder and post traumatic stress disorder Mood disorder Mood 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 also known as unipolar 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 moods The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder or mix and merge along a dimension or spectrum of mood is subject to some scientific debate 40 41 Psychotic disorder Psychotic disorder Patterns of belief language use and perception of reality can become dysregulated 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 cutoff criteria Personality disorder Personality disorder Personality the fundamental characteristics of a person that influence thoughts and behaviors across situations and time may be considered disordered if judged to be abnormally rigid and maladaptive Although treated separately by some the commonly used categorical schemes include them as mental disorders albeit on a separate axis II in the case of the DSM IV A number of different personality disorders are listed including those sometimes classed as eccentric such as paranoid schizoid and schizotypal personality disorders types that have described as dramatic or emotional such as antisocial borderline histrionic or narcissistic personality disorders and those sometimes classed as fear related such as anxious avoidant dependent or obsessive compulsive personality disorders Personality disorders in general are defined as emerging in childhood or at least by adolescence or early adulthood The ICD also has a category for enduring personality change after a catastrophic experience or psychiatric illness 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 personality disorders similar to personality traits in general incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods and maladaptive temperamental traits that are more enduring 42 Furthermore there are also non categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom based cutoff from normal personality variation for example through schemes based on dimensional models 43 non primary source needed Eating disorder Eating disorders involve disproportionate concern in matters of food and weight 37 Categories of disorder in this area include anorexia nervosa bulimia nervosa exercise bulimia or binge eating disorder 44 45 Sleep disorder Sleep disorders are associated with disruption to normal sleep patterns A common sleep disorder is insomnia which is described as difficulty falling and or staying asleep Sexuality related Sexual disorders include dyspareunia and various kinds of paraphilia sexual arousal to objects situations or individuals that are considered abnormal or harmful to the person or others Other Impulse control disorder People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others may be classified as having an impulse control disorder 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 Substance use disorder This disorder refers to the use of drugs legal or illegal including alcohol that persists despite significant problems or harm related to its use Substance dependence and substance abuse fall under this umbrella category in the DSM Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped Dissociative disorder People who suffer severe disturbances of their self identity memory and general awareness of themselves and their surroundings may be classified as having these types of disorders including depersonalization disorder or dissociative identity disorder which was previously referred to as multiple personality disorder or split personality Cognitive disorder These affect cognitive abilities including learning and memory This category includes delirium and mild and major neurocognitive disorder previously termed dementia Developmental disorder These disorders initially occur in childhood Some examples include autism spectrum disorder 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 Popular labels such as psychopath or sociopath do not appear in the DSM or ICD but are linked by some to these diagnoses Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder This includes somatization disorder and conversion disorder There are also disorders of how a person perceives their body such as 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 46 non primary source needed Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain Symptoms are often deliberately produced or feigned and may relate to either symptoms in the individual or in someone close to them particularly people they care for 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 There are a number of uncommon psychiatric syndromes which are often named after the person who first described them such as Capgras syndrome De Clerambault syndrome Othello syndrome Ganser syndrome Cotard delusion and Ekbom syndrome and additional disorders such as the Couvade syndrome and Geschwind syndrome 47 Various new types of mental disorder diagnoses 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 gender dysphoria and premenstrual dysphoric disorder Signs and symptomsCourse The onset of psychiatric disorders usually occurs from childhood to early adulthood 48 Impulse control disorders and a few anxiety disorders tend to appear in childhood Some other anxiety disorders substance disorders and mood disorders emerge later in the mid teens 49 Symptoms of schizophrenia typically manifest from late adolescence to early twenties 50 The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself the individual as a whole and the social environment Some disorders may last a brief period of time while others may be long term in nature All disorders can have a varied course Long term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms and around a fifth to a third in terms of symptoms and functioning with many requiring no medication While some have serious difficulties and support needs for many years late recovery is still plausible The World Health Organization concluded that the long term studies findings converged with others in relieving patients carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century 51 non primary source needed 52 A follow up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery no longer meeting criteria for the diagnosis within six weeks and nearly all achieve it within two years with nearly half regaining their prior occupational and residential status in that period Less than half go on to experience a new episode of mania or major depression within the next two years 53 non primary source needed Disability Disorder Disability adjusted life years 54 Major depressive disorder 65 5 millionAlcohol use disorder 23 7 millionSchizophrenia 16 8 millionBipolar disorder 14 4 millionOther drug use disorders 8 4 millionPanic disorder 7 0 millionObsessive compulsive disorder 5 1 millionPrimary insomnia 3 6 millionPost traumatic stress disorder 3 5 million Some disorders may be very limited in their functional effects while others may involve substantial disability and support needs The degree of ability or disability may vary over time and across different life domains Furthermore continued disability has been linked to institutionalization discrimination and social exclusion as well as to the inherent effects of disorders Alternatively functioning may be affected by the stress of having to hide a condition in work or school etc by adverse effects of medications or other substances or by mismatches between illness related variations and demands for regularity 55 It is also the case that while often being characterized in purely negative terms some mental traits or states labeled as disorders can also involve above average creativity non conformity goal striving meticulousness or empathy 56 In addition the public perception of the level of disability associated with mental disorders can change 57 Nevertheless internationally people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions particularly in their social roles and personal relationships The proportion with access to professional help for mental disorders is far lower however even among those assessed as having a severely disabling condition 58 Disability in this context may or may not involve such things as Basic activities of daily living Including looking after the self health care grooming dressing shopping cooking etc or looking after accommodation chores DIY tasks etc Interpersonal relationships Including communication skills ability to form relationships and sustain them ability to leave the home or mix in crowds or particular settings Occupational functioning Ability to acquire an employment and hold it cognitive and social skills required for the job dealing with workplace culture or studying as a student In terms of total disability adjusted life years DALYs which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability mental disorders rank amongst the most disabling conditions Unipolar also known as Major depressive disorder is the third leading cause of disability worldwide of any condition mental or physical accounting for 65 5 million years lost The first systematic description of global disability arising in youth in 2011 found that among 10 to 24 year olds nearly half of all disability current and as estimated to continue was due to mental and neurological conditions including substance use disorders and conditions involving self harm Second to this were accidental injuries mainly traffic collisions accounting for 12 percent of disability followed by communicable diseases at 10 percent The disorders associated with most disabilities in high income countries were unipolar major depression 20 and alcohol use disorder 11 In the eastern Mediterranean region it was unipolar major depression 12 and schizophrenia 7 and in Africa it was unipolar major depression 7 and bipolar disorder 5 59 Suicide which is often attributed to some underlying mental disorder is a leading cause of death among teenagers and adults under 35 60 61 There are an estimated 10 to 20 million non fatal attempted suicides every year worldwide 62 Risk factorsMain article Causes of mental disorders The predominant view as of 2018 is that genetic psychological and environmental factors all contribute to the development or progression of mental disorders 63 Different risk factors may be present at different ages with risk occurring as early as during prenatal period 64 Genetics Main article Psychiatric genetics A number of psychiatric disorders are linked to a family history including depression narcissistic personality disorder 65 66 and anxiety 67 Twin studies have also revealed a very high heritability for many mental disorders especially autism and schizophrenia 68 Although researchers have been looking for decades for clear linkages between genetics and mental disorders that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments 69 Statistical research looking at eleven disorders found widespread assortative mating between people with mental illness That means that individuals with one of these disorders were two to three times more likely than the general population to have a partner with a mental disorder Sometimes people seemed to have preferred partners with the same mental illness Thus people with schizophrenia or ADHD are seven times more likely to have affected partners with the same disorder This is even more pronounced for people with Autism spectrum disorders who are 10 times more likely to have a spouse with the same disorder 70 Environment The prevalence of mental illness is higher in more economically unequal countries During the prenatal stage factors like unwanted pregnancy lack of adaptation to pregnancy or substance use during pregnancy increases the risk of developing a mental disorder 64 Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness 71 Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment 64 Social influences have also been found to be important 72 including abuse neglect bullying social stress traumatic events and other negative or overwhelming life experiences Aspects of the wider community have also been implicated 73 including employment problems socioeconomic inequality lack of social cohesion problems linked to migration and features of particular societies and cultures The specific risks and pathways to particular disorders are less clear however Nutrition also plays a role in mental disorders 7 74 In schizophrenia and psychosis risk factors include migration and discrimination childhood trauma bereavement or separation in families recreational use of drugs 75 and urbanicity 73 In anxiety risk factors may include parenting factors including parental rejection lack of parental warmth high hostility harsh discipline high maternal negative affect anxious childrearing modelling of dysfunctional and drug abusing behaviour and child abuse emotional physical and sexual 76 Adults with imbalance work to life are at higher risk for developing anxiety 64 For bipolar disorder stress such as childhood adversity is not a specific cause but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness 77 Drug use Mental disorders are associated with drug use including cannabis 78 alcohol 79 and caffeine 80 use of which appears to promote anxiety 81 For psychosis and schizophrenia usage of a number of drugs has been associated with development of the disorder including cannabis cocaine and amphetamines 82 78 There has been debate regarding the relationship between usage of cannabis and bipolar disorder 83 Cannabis has also been associated with depression 78 Adolescents are at increased risk for tobacco alcohol and drug use Peer pressure is the main reason why adolescents start using substances At this age the use of substances could be detrimental to the development of the brain and place them at higher risk of developing a mental disorder 64 Chronic disease People living with chronic conditions like HIV and diabetes are at higher risk of developing a mental disorder People living with diabetes experience significant stress from biological impact of the disease which places them at risk for developing anxiety and depression Diabetic patients also have to deal with emotional stress trying to manage the disease Conditions like heart disease stroke respiratory conditions cancer and arthritis increase the risk of developing a mental disorder when compared to the general population 84 Personality traits Risk factors for mental illness include a propensity for high neuroticism 85 86 or emotional instability In anxiety risk factors may include temperament and attitudes e g pessimism 67 Causal models Mental disorders can arise from multiple sources and in many cases there is no single accepted or consistent cause currently established An eclectic or pluralistic mix of models may be used to explain particular disorders 86 87 The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial model which incorporates biological psychological and social factors although this may not always be applied in practice Biological psychiatry follows a biomedical model where many mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience A common assumption is that disorders may have resulted from genetic and developmental vulnerabilities exposed by stress in life for example in a diathesis stress model although there are various views on what causes differences between individuals Some types of mental disorders may be viewed as primarily neurodevelopmental disorders Evolutionary psychology may be used as an overall explanatory theory while attachment theory is another kind of evolutionary psychological approach sometimes applied in the context of mental disorders Psychoanalytic theories have continued to evolve alongside and cognitive behavioral and systemic family approaches A distinction is sometimes made between a medical model or a social model of disorder and disability DiagnosisPsychiatrists seek to provide a medical diagnosis of individuals by an assessment of symptoms signs and impairment associated with particular types of mental disorder Other mental health professionals such as clinical psychologists may or may not apply the same diagnostic categories to their clinical formulation of a client s difficulties and circumstances 88 The majority of mental health problems are at least initially assessed and treated by family physicians in the UK general practitioners during consultations who may refer a patient on for more specialist diagnosis in acute or chronic cases Routine diagnostic practice in mental health services typically involves an interview known as a mental status examination where evaluations are made of appearance and behavior self reported symptoms mental health history and current life circumstances The views of other professionals relatives or other third parties may be taken into account A physical examination to check for ill health or the effects of medications or other drugs may be conducted Psychological testing is sometimes used via paper and pen or computerized questionnaires which may include algorithms based on ticking off standardized diagnostic criteria and in rare specialist cases neuroimaging tests may be requested but such methods are more commonly found in research studies than routine clinical practice 89 90 Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations 91 It has been found that most clinicians evaluate patients using an unstructured open ended approach with limited training in evidence based assessment methods and that inaccurate diagnosis may be common in routine practice 92 In addition comorbidity is very common in psychiatric diagnosis where the same person meets the criteria for more than one disorder On the other hand a person may have several different difficulties only some of which meet the criteria for being diagnosed There may be specific problems with accurate diagnosis in developing countries More structured approaches are being increasingly used to measure levels of mental illness HoNOS is the most widely used measure in English mental health services being used by at least 61 trusts 93 In HoNOS a score of 0 4 is given for each of 12 factors based on functional living capacity 94 Research has been supportive of HoNOS 95 although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment 96 Criticism This section relies too much on references to primary sources Please improve this section by adding secondary or tertiary sources July 2021 Learn how and when to remove this template message Since the 1980s Paula Caplan has been concerned about the subjectivity of psychiatric diagnosis and people being arbitrarily slapped with a psychiatric label Caplan says because psychiatric diagnosis is unregulated doctors are not required to spend much time interviewing patients or to seek a second opinion The Diagnostic and Statistical Manual of Mental Disorders can lead a psychiatrist to focus on narrow checklists of symptoms with little consideration of what is actually causing the person s problems So according to Caplan getting a psychiatric diagnosis and label often stands in the way of recovery 97 unreliable medical source In 2013 psychiatrist Allen Frances wrote a paper entitled The New Crisis of Confidence in Psychiatric Diagnosis which said that psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests Frances was also concerned about unpredictable overdiagnosis 98 For many years marginalized psychiatrists such as Peter Breggin Thomas Szasz and outside critics such as Stuart A Kirk have been accusing psychiatry of engaging in the systematic medicalization of normality More recently these concerns have come from insiders who have worked for and promoted the American Psychiatric Association e g Robert Spitzer Allen Frances 99 A 2002 editorial in the British Medical Journal warned of inappropriate medicalization leading to disease mongering where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden the market for medications 100 Gary Greenberg a psychoanalyst in his book the Book of Woe argues that mental illness is really about suffering and how the DSM creates diagnostic labels to categorize people s suffering 101 Indeed the psychiatrist Thomas Szasz in his book the Medicalization of Everyday Life also argues that what is psychiatric illness is not always biological in nature i e social problems poverty etc and may even be a part of the human condition 102 PreventionMain article Prevention of mental disorders The 2004 WHO report Prevention of Mental Disorders stated that Prevention of these disorders is obviously one of the most effective ways to reduce the disease burden 103 The 2011 European Psychiatric Association EPA guidance on prevention of mental disorders states There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence based interventions 104 A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that many interventions are outstandingly good value for money low in cost and often become self financing over time saving public expenditure 105 In 2016 the National Institute of Mental Health re affirmed prevention as a research priority area 106 Parenting may affect the child s mental health and evidence suggests that helping parents to be more effective with their children can address mental health needs 107 108 Universal prevention aimed at a population that has no increased risk for developing a mental disorder such as school programs or mass media campaigns need very high numbers of people to show effect sometimes known as the power problem Approaches to overcome this are 1 focus on high incidence groups e g by targeting groups with high risk factors 2 use multiple interventions to achieve greater and thus more statistically valid effects 3 use cumulative meta analyses of many trials and 4 run very large trials 109 110 ManagementMain articles Treatment of mental disorders Services for mental disorders and Mental health professional Haus Tornow am See former manor house Germany from 1912 is today separated into a special education school and a hotel with integrated work job and rehabilitation training for people with mental disorders Treatment and support for mental disorders are provided in psychiatric hospitals clinics or a range of community mental health services In some countries services are increasingly based on a recovery approach intended to support individual s personal journey to gain the kind of life they want There is a range of different types of treatment and what is most suitable depends on the disorder and the individual Many things have been found to help at least some people and a placebo effect may play a role in any intervention or medication In a minority of cases individuals may be treated against their will which can cause particular difficulties depending on how it is carried out and perceived Compulsory treatment while in the community versus non compulsory treatment does not appear to make much of a difference except by maybe decreasing victimization 111 Lifestyle Lifestyle strategies including dietary changes exercise and quitting smoking may be of benefit 9 74 112 Therapy There is also a wide range of psychotherapists including family therapy counselors and public health professionals In addition there are peer support roles where personal experience of similar issues is the primary source of expertise 113 114 115 116 A major option for many mental disorders is psychotherapy There are several main types Cognitive behavioral therapy CBT is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder Other psychotherapies include dialectic behavioral therapy DBT and interpersonal psychotherapy IPT Psychoanalysis addressing underlying psychic conflicts and defenses has been a dominant school of psychotherapy and is still in use Systemic therapy or family therapy is sometimes used addressing a network of significant others as well as an individual Some psychotherapies are based on a humanistic approach There are many specific therapies used for particular disorders which may be offshoots or hybrids of the above types Mental health professionals often employ an eclectic or integrative approach Much may depend on the therapeutic relationship and there may be problems with trust confidentiality and engagement Medication A major option for many mental disorders is psychiatric medication and there are several main groups Antidepressants are used for the treatment of clinical depression as well as often for anxiety and a range of other disorders Anxiolytics including sedatives are used for anxiety disorders and related problems such as insomnia Mood stabilizers are used primarily in bipolar disorder Antipsychotics are used for psychotic disorders notably for positive symptoms in schizophrenia and also increasingly for a range of other disorders Stimulants are commonly used notably for ADHD 117 Despite the different conventional names of the drug groups there may be considerable overlap in the disorders for which they are actually indicated and there may also be off label use of medications There can be problems with adverse effects of medication and adherence to them and there is also criticism of pharmaceutical marketing and professional conflicts of interest However these medications in combination with non pharmacological methods such as cognitive behavioral therapy CBT are seen to be most effective in treating mental disorders Other Electroconvulsive therapy ECT is sometimes used in severe cases when other interventions for severe intractable depression have failed ECT is usually indicated for treatment resistant depression severe vegetative symptoms psychotic depression intense suicidal ideation depression during pregnancy and catonia Psychosurgery is considered experimental but is advocated by some neurologists in certain rare cases 118 119 Counseling professional and co counseling between peers may be used Psychoeducation programs may provide people with the information to understand and manage their problems Creative therapies are sometimes used including music therapy art therapy or drama therapy Lifestyle adjustments and supportive measures are often used including peer support self help groups for mental health and supported housing or supported employment including social firms Some advocate dietary supplements 120 Reasonable accommodations adjustments and supports might be put in place to help an individual cope and succeed in environments despite potential disability related to mental health problems This could include an emotional support animal or specifically trained psychiatric service dog As of 2019 cannabis is specifically not recommended as a treatment 121 EpidemiologyMain article Prevalence of mental disorders Deaths from mental and behavioral disorders per million persons in 2012 0 6 7 9 10 15 16 24 25 31 32 39 40 53 54 70 71 99 100 356 Disability adjusted life year for neuropsychiatric conditions per 100 000 inhabitants in 2004 lt 2 200 2 200 2 400 2 400 2 600 2 600 2 800 2 800 3 000 3 000 3 200 3 200 3 400 3 400 3 600 3 600 3 800 3 800 4 000 4 000 4 200 gt 4 200 Mental disorders are common Worldwide more than one in three people in most countries report sufficient criteria for at least one at some point in their life 122 In the United States 46 qualify for a mental illness at some point 123 An ongoing survey indicates that anxiety disorders are the most common in all but one country followed by mood disorders in all but two countries while substance disorders and impulse control disorders were consistently less prevalent 124 Rates varied by region 125 A review of anxiety disorder surveys in different countries found average lifetime prevalence estimates of 16 6 with women having higher rates on average 126 A review of mood disorder surveys in different countries found lifetime rates of 6 7 for major depressive disorder higher in some studies and in women and 0 8 for Bipolar I disorder 127 In the United States the frequency of disorder is anxiety disorder 28 8 mood disorder 20 8 impulse control disorder 24 8 or substance use disorder 14 6 123 128 129 A 2004 cross Europe study found that approximately one in four people reported meeting criteria at some point in their life for at least one of the DSM IV disorders assessed which included mood disorders 13 9 anxiety disorders 13 6 or alcohol disorder 5 2 Approximately one in ten met the criteria within a 12 month period Women and younger people of either gender showed more cases of the disorder 130 A 2005 review of surveys in 16 European countries found that 27 of adult Europeans are affected by at least one mental disorder in a 12 month period 131 An international review of studies on the prevalence of schizophrenia found an average median figure of 0 4 for lifetime prevalence it was consistently lower in poorer countries 132 Studies of the prevalence of personality disorders PDs have been fewer and smaller scale but one broad Norwegian survey found a five year prevalence of almost 1 in 7 13 4 Rates for specific disorders ranged from 0 8 to 2 8 differing across countries and by gender educational level and other factors 133 A US survey that incidentally screened for personality disorder found a rate of 14 79 134 Approximately 7 of a preschool pediatric sample were given a psychiatric diagnosis in one clinical study and approximately 10 of 1 and 2 year olds receiving developmental screening have been assessed as having significant emotional behavioral problems based on parent and pediatrician reports 135 While rates of psychological disorders are often the same for men and women women tend to have a higher rate of depression Each year 73 million women are affected by major depression and suicide is ranked 7th as the cause of death for women between the ages of 20 59 Depressive disorders account for close to 41 9 of the disability from neuropsychiatric disorders among women compared to 29 3 among men 136 HistoryMain article History of mental disorders Ancient civilizations Ancient civilizations described and treated a number of mental disorders Mental illnesses were well known in ancient Mesopotamia 137 where diseases and mental disorders were believed to be caused by specific deities 138 Because hands symbolized control over a person mental illnesses were known as hands of certain deities 138 One psychological illness was known as Qat Istar meaning Hand of Ishtar 138 Others were known as Hand of Shamash Hand of the Ghost and Hand of the God 138 Descriptions of these illnesses however are so vague that it is usually impossible to determine which illnesses they correspond to in modern terminology 138 Mesopotamian doctors kept detailed record of their patients hallucinations and assigned spiritual meanings to them 137 The royal family of Elam was notorious for its members frequently suffering from insanity 137 The Greeks coined terms for melancholy hysteria and phobia and developed the humorism theory Mental disorders were described and treatments developed in Persia Arabia and in the medieval Islamic world Europe Middle Ages Conceptions of madness in the Middle Ages in Christian Europe were a mixture of the divine diabolical magical and humoral and transcendental 139 In the early modern period some people with mental disorders may have been victims of the witch hunts While not every witch and sorcerer accused were mentally ill all mentally ill were considered to be witches or sorcerers 140 Many terms for mental disorders that found their way into everyday use first became popular in the 16th and 17th centuries Eighteenth century Eight patients representing mental diagnoses as of the 19th century at the Salpetriere Paris By the end of the 17th century and into the Enlightenment madness was increasingly seen as an organic physical phenomenon with no connection to the soul or moral responsibility Asylum care was often harsh and treated people like wild animals but towards the end of the 18th century a moral treatment movement gradually developed Clear descriptions of some syndromes may be rare before the 19th century Nineteenth century Industrialization and population growth led to a massive expansion of the number and size of insane asylums in every Western country in the 19th century Numerous different classification schemes and diagnostic terms were developed by different authorities and the term psychiatry was coined 1808 though medical superintendents were still known as alienists Twentieth century A patient in a strait jacket and barrel contraption 1908 The turn of the 20th century saw the development of psychoanalysis which would later come to the fore along with Kraepelin s classification scheme Asylum inmates were increasingly referred to as patients and asylums were renamed as hospitals Europe and the United States Insulin shock procedure 1950s Early in the 20th century in the United States a mental hygiene movement developed aiming to prevent mental disorders Clinical psychology and social work developed as professions World War I saw a massive increase of conditions that came to be termed shell shock World War II saw the development in the U S of a new psychiatric manual for categorizing mental disorders which along with existing systems for collecting census and hospital statistics led to the first Diagnostic and Statistical Manual of Mental Disorders The International Classification of Diseases ICD also developed a section on mental disorders The term stress having emerged from endocrinology work in the 1930s was increasingly applied to mental disorders Electroconvulsive therapy insulin shock therapy lobotomies and the neuroleptic chlorpromazine came to be used by mid century 141 In the 1960s there were many challenges to the concept of mental illness itself These challenges came from psychiatrists like Thomas Szasz who argued that mental illness was a myth used to disguise moral conflicts from sociologists such as Erving Goffman who said that mental illness was merely another example of how society labels and controls non conformists from behavioral psychologists who challenged psychiatry s fundamental reliance on unobservable phenomena and from gay rights activists who criticised the APA s listing of homosexuality as a mental disorder A study published in Science by Rosenhan received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis 142 Deinstitutionalization gradually occurred in the West with isolated psychiatric hospitals being closed down in favor of community mental health services A consumer survivor movement gained momentum Other kinds of psychiatric medication gradually came into use such as psychic energizers later antidepressants and lithium Benzodiazepines gained widespread use in the 1970s for anxiety and depression until dependency problems curtailed their popularity Advances in neuroscience genetics and psychology led to new research agendas Cognitive behavioral therapy and other psychotherapies developed The DSM and then ICD adopted new criteria based classifications and the number of official diagnoses saw a large expansion Through the 1990s new SSRI type antidepressants became some of the most widely prescribed drugs in the world as later did antipsychotics Also during the 1990s a recovery approach developed Society and culture Different societies or cultures even different individuals in a subculture can disagree as to what constitutes optimal versus pathological biological and psychological functioning Research has demonstrated that cultures vary in the relative importance placed on for example happiness autonomy or social relationships for pleasure Likewise the fact that a behavior pattern is valued accepted encouraged or even statistically normative in a culture does not necessarily mean that it is conducive to optimal psychological functioning People in all cultures find some behaviors bizarre or even incomprehensible But just what they feel is bizarre or incomprehensible is ambiguous and subjective 143 These differences in determination can become highly contentious The process by which conditions and difficulties come to be defined and treated as medical conditions and problems and thus come under the authority of doctors and other health professionals is known as medicalization or pathologization Religion See also Psychology of religion Religious spiritual or transpersonal experiences and beliefs meet many criteria of delusional or psychotic disorders 144 145 A belief or experience can sometimes be shown to produce distress or disability the ordinary standard for judging mental disorders 146 There is a link between religion and schizophrenia 147 a complex mental disorder characterized by a difficulty in recognizing reality regulating emotional responses and thinking in a clear and logical manner Those with schizophrenia commonly report some type of religious delusion 147 148 149 and religion itself may be a trigger for schizophrenia 150 Movements Giorgio Antonucci Thomas Szasz Controversy has often surrounded psychiatry and the term anti psychiatry was coined by the psychiatrist David Cooper in 1967 The anti psychiatry message is that psychiatric treatments are ultimately more damaging than helpful to patients and psychiatry s history involves what may now be seen as dangerous treatments 151 Electroconvulsive therapy was one of these which was used widely between the 1930s and 1960s Lobotomy was another practice that was ultimately seen as too invasive and brutal Diazepam and other sedatives were sometimes over prescribed which led to an epidemic of dependence There was also concern about the large increase in prescribing psychiatric drugs for children Some charismatic psychiatrists came to personify the movement against psychiatry The most influential of these was R D Laing who wrote a series of best selling books including The Divided Self Thomas Szasz wrote The Myth of Mental Illness Some ex patient groups have become militantly anti psychiatric often referring to themselves as survivors 151 Giorgio Antonucci has questioned the basis of psychiatry through his work on the dismantling of two psychiatric hospitals in the city of Imola carried out from 1973 to 1996 The consumer survivor movement also known as user survivor movement is made up of individuals and organizations representing them who are clients of mental health services or who consider themselves survivors of psychiatric interventions Activists campaign for improved mental health services and for more involvement and empowerment within mental health services policies and wider society 152 153 154 Patient advocacy organizations have expanded with increasing deinstitutionalization in developed countries working to challenge the stereotypes stigma and exclusion associated with psychiatric conditions There is also a carers rights movement of people who help and support people with mental health conditions who may be relatives and who often work in difficult and time consuming circumstances with little acknowledgement and without pay An anti psychiatry movement fundamentally challenges mainstream psychiatric theory and practice including in some cases asserting that psychiatric concepts and diagnoses of mental illness are neither real nor useful 155 156 157 Alternatively a movement for global mental health has emerged defined as the area of study research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide 158 Cultural bias See also Depression and culture and Cultural competence in healthcare Current diagnostic guidelines namely the DSM and to some extent the ICD have been criticized as having a fundamentally Euro American outlook Opponents argue that even when diagnostic criteria are used across different cultures it does not mean that the underlying constructs have validity within those cultures as even reliable application can prove only consistency not legitimacy 159 Advocating a more culturally sensitive approach critics such as Carl Bell and Marcello Maviglia contend that the cultural and ethnic diversity of individuals is often discounted by researchers and service providers 160 Cross cultural psychiatrist Arthur Kleinman contends that the Western bias is ironically illustrated in the introduction of cultural factors to the DSM IV Disorders or concepts from non Western or non mainstream cultures are described as culture bound whereas standard psychiatric diagnoses are given no cultural qualification whatsoever revealing to Kleinman an underlying assumption that Western cultural phenomena are universal 161 Kleinman s negative view towards the culture bound syndrome is largely shared by other cross cultural critics Common responses included both disappointment over the large number of documented non Western mental disorders still left out and frustration that even those included are often misinterpreted or misrepresented 162 Many mainstream psychiatrists are dissatisfied with the new culture bound diagnoses although for partly different reasons Robert Spitzer a lead architect of the DSM III has argued that adding cultural formulations was an attempt to appease cultural critics and has stated that they lack any scientific rationale or support Spitzer also posits that the new culture bound diagnoses are rarely used maintaining that the standard diagnoses apply regardless of the culture involved In general mainstream psychiatric opinion remains that if a diagnostic category is valid cross cultural factors are either irrelevant or are significant only to specific symptom presentations 159 Clinical conceptions of mental illness also overlap with personal and cultural values in the domain of morality so much so that it is sometimes argued that separating the two is impossible without fundamentally redefining the essence of being a particular person in a society 163 In clinical psychiatry persistent distress and disability indicate an internal disorder requiring treatment but in another context that same distress and disability can be seen as an indicator of emotional struggle and the need to address social and structural problems 164 165 This dichotomy has led some academics and clinicians to advocate a postmodernist conceptualization of mental distress and well being 166 167 Such approaches along with cross cultural and heretical psychologies centered on alternative cultural and ethnic and race based identities and experiences stand in contrast to the mainstream psychiatric community s alleged avoidance of any explicit involvement with either morality or culture 168 In many countries there are attempts to challenge perceived prejudice against minority groups including alleged institutional racism within psychiatric services 169 There are also ongoing attempts to improve professional cross cultural sensitivity Laws and policies See also Mental health law Three quarters of countries around the world have mental health legislation Compulsory admission to mental health facilities also known as involuntary commitment is a controversial topic It can impinge on personal liberty and the right to choose and carry the risk of abuse for political social and other reasons yet it can potentially prevent harm to self and others and assist some people in attaining their right to healthcare when they may be unable to decide in their own interests 170 Because of this it is a concern of medical ethics All human rights oriented mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards but the type and severity of disorder that counts can vary in different jurisdictions The two most often used grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others and the need for treatment Applications for someone to be involuntarily admitted usually come from a mental health practitioner a family member a close relative or a guardian Human rights oriented laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular time bound review by an independent review body 170 The individual should also have personal access to independent advocacy For involuntary treatment to be administered by force if necessary it should be shown that an individual lacks the mental capacity for informed consent i e to understand treatment information and its implications and therefore be able to make an informed choice to either accept or refuse Legal challenges in some areas have resulted in supreme court decisions that a person does not have to agree with a psychiatrist s characterization of the issues as constituting an illness nor agree with a psychiatrist s conviction in medication but only recognize the issues and the information about treatment options 171 Proxy consent also known as surrogate or substituted decision making may be transferred to a personal representative a family member or a legally appointed guardian Moreover patients may be able to make when they are considered well an advance directive stipulating how they wish to be treated should they be deemed to lack mental capacity in the future 170 The right to supported decision making where a person is helped to understand and choose treatment options before they can be declared to lack capacity may also be included in the legislation 172 There should at the very least be shared decision making as far as possible Involuntary treatment laws are increasingly extended to those living in the community for example outpatient commitment laws known by different names are used in New Zealand Australia the United Kingdom and most of the United States The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights and is often outdated 170 In 1991 the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care which established minimum human rights standards of practice in the mental health field In 2006 the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people including those with psychosocial disabilities 173 The term insanity sometimes used colloquially as a synonym for mental illness is often used technically as a legal term The insanity defense may be used in a legal trial known as the mental disorder defence in some countries Perception and discrimination Further information Schizophrenogenic parents Refrigerator mother and Mentalism discrimination Stigma The social stigma associated with mental disorders is a widespread problem The US Surgeon General stated in 1999 that Powerful and pervasive stigma prevents people from acknowledging their own mental health problems much less disclosing them to others 174 In the United States racial and ethnic minorities are more likely to experience mental health disorders often due to low socioeconomic status and discrimination 175 176 In Taiwan those with mental disorders are subject to general public s misperception that the root causes of the mental disorders are over thinking having a lot of time and nothing better to do stagnant not serious in life not paying enough attention to the real life affairs mentally weak refusing to be resilient turning back to perfectionistic strivings not bravery and so forth 177 Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness 178 An Australian study found that having a mental illness is a bigger barrier to employment than a physical disability 179 better source needed The mentally ill are stigmatized in Chinese society and can not legally marry 180 Efforts are being undertaken worldwide to eliminate the stigma of mental illness 181 although the methods and outcomes used have sometimes been criticized 182 Media and general public Main article Mental disorders in art and literature Media coverage of mental illness comprises predominantly negative and pejorative depictions for example of incompetence violence or criminality with far less coverage of positive issues such as accomplishments or human rights issues 183 184 185 Such negative depictions including in children s cartoons are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves although more sensitive or serious cinematic portrayals have increased in prevalence 186 187 In the United States the Carter Center has created fellowships for journalists in South Africa the U S and Romania to enable reporters to research and write stories on mental health topics 188 Former US First Lady Rosalynn Carter began the fellowships not only to train reporters in how to sensitively and accurately discuss mental health and mental illness but also to increase the number of stories on these topics in the news media 189 190 There is also a World Mental Health Day which in the US and Canada falls within a Mental Illness Awareness Week The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill 191 A US national survey found that a higher percentage of people rate individuals described as displaying the characteristics of a mental disorder as likely to do something violent to others compared to the percentage of people who are rating individuals described as being troubled 192 Recent depictions in media have included leading characters successfully living with and managing a mental illness including in bipolar disorder in Homeland 2011 and posttraumatic stress disorder in Iron Man 3 2013 original research Violence Despite public or media opinion national studies have indicated that severe mental illness does not independently predict future violent behavior on average and is not a leading cause of violence in society There is a statistical association with various factors that do relate to violence in anyone such as substance use and various personal social and economic factors 193 A 2015 review found that in the United States about 4 of violence is attributable to people diagnosed with mental illness 194 and a 2014 study found that 7 5 of crimes committed by mentally ill people were directly related to the symptoms of their mental illness 195 The majority of people with serious mental illness are never violent 196 In fact findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victims rather than the perpetrators of violence 197 198 In a study of individuals diagnosed with severe mental illness living in a US inner city area a quarter were found to have been victims of at least one violent crime over the course of a year a proportion eleven times higher than the inner city average and higher in every category of crime including violent assaults and theft 199 People with a diagnosis may find it more difficult to secure prosecutions however due in part to prejudice and being seen as less credible 200 However there are some specific diagnoses such as childhood conduct disorder or adult antisocial personality disorder or psychopathy which are defined by or are inherently associated with conduct problems and violence There are conflicting findings about the extent to which certain specific symptoms notably some kinds of psychosis hallucinations or delusions that can occur in disorders such as schizophrenia delusional disorder or mood disorder are linked to an increased risk of serious violence on average The mediating factors of violent acts however are most consistently found to be mainly socio demographic and socio economic factors such as being young male of lower socioeconomic status and in particular substance use including alcohol use to which some people may be particularly vulnerable 56 197 201 202 High profile cases have led to fears that serious crimes such as homicide have increased due to deinstitutionalization but the evidence does not support this conclusion 202 203 Violence that does occur in relation to mental disorder against the mentally ill or by the mentally ill typically occurs in the context of complex social interactions often in a family setting rather than between strangers 204 It is also an issue in health care settings 205 and the wider community 206 Mental healthMain article Mental health The recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition assessment and classification although standard guideline criteria are widely used In many cases there appears to be a continuum between mental health and mental illness making diagnosis complex 38 39 According to the World Health Organization WHO over a third of people in most countries report problems at some time in their life which meet the criteria for diagnosis of one or more of the common types of mental disorder 122 Corey M Keyes has created a two continua model of mental illness and health which holds that both are related but distinct dimensions one continuum indicates the presence or absence of mental health the other the presence or absence of mental illness 207 For example people with optimal mental health can also have a mental illness and people who have no mental illness can also have poor mental health 208 Other animalsMain article Animal psychopathology Psychopathology in non human primates has been studied since the mid 20th century Over 20 behavioral patterns in captive chimpanzees have been documented as statistically abnormal for frequency severity or oddness some of which have also been observed in the wild Captive great apes show gross behavioral abnormalities such as stereotypy of movements self mutilation disturbed emotional reactions mainly fear or aggression towards companions lack of species typical communications and generalized learned helplessness In some cases such behaviors are hypothesized to be equivalent to symptoms associated with psychiatric disorders in humans such as depression anxiety disorders eating disorders and post traumatic stress disorder Concepts of antisocial borderline and schizoid personality disorders have also been applied to non human great apes 209 210 The risk of anthropomorphism is often raised concerning such comparisons and assessment of non human animals cannot incorporate evidence from linguistic communication However available evidence may range from nonverbal behaviors including physiological responses and homologous facial displays and acoustic utterances to neurochemical studies It is pointed out that human psychiatric classification is often based on statistical description and judgment of behaviors especially when speech or language is impaired and that the use of verbal self report is itself problematic and unreliable 209 211 Psychopathology has generally been traced at least in captivity to adverse rearing conditions such as early separation of infants from mothers early sensory deprivation and extended periods of social isolation Studies have also indicated individual variation in temperament such as sociability or impulsiveness Particular causes of problems in captivity have included integration of strangers into existing groups and a lack of individual space in which context some pathological behaviors have also been seen as coping mechanisms Remedial interventions have included careful individually tailored re socialization programs behavior therapy environment enrichment and on rare occasions psychiatric drugs Socialization has been found to work 90 of the time in disturbed chimpanzees although restoration of functional sexuality and caregiving is often not achieved 209 212 Laboratory researchers sometimes try to develop animal models of human mental disorders including by inducing or treating symptoms in animals through genetic neurological chemical or behavioral manipulation 213 214 but this has been criticized on empirical grounds 215 and opposed on animal rights grounds See also Philosophy portal Psychiatry portal Psychology portal Society portal List of mental disorders Mental illness portrayed in media Mental disorders in film Mental illness in fiction Mental illness in American prisons Parity of esteem Psychological evaluationNotes Mental illness Symptoms and causes Mayo Clinic 8 June 2019 Retrieved 3 May 2020 Any Mental Illness AMI Among U S Adults National Institute of Mental Health U S Department of Health and Human Services Archived from the original on 7 April 2017 Retrieved 28 April 2017 Mental Disorders Medline Plus U S National Library of Medicine 15 September 2014 Archived from the original on 8 May 2016 Retrieved 10 June 2016 Bolton D 2008 What is Mental Disorder An Essay in Philosophy Science and Values OUP Oxford p 6 ISBN 978 0 19 856592 5 Mental disorders World Health Organization 9 April 2018 Archived from the original on 18 May 2015 Retrieved 2 February 2019 Mental disorders World Health Organization Archived from the original on 29 March 2016 Retrieved 9 April 2016 a b c Mental disorders World Health Organization October 2014 Archived from the original on 18 May 2015 Retrieved 13 May 2015 American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders 5th ed Arlington VA American Psychiatric Publishing pp 101 05 ISBN 978 0 89042 555 8 a b Jacka FN March 2017 Nutritional Psychiatry Where to Next EBioMedicine Review 17 17 24 29 doi 10 1016 j ebiom 2017 02 020 PMC 5360575 PMID 28242200 a b Mental Disorders World Health Organization World Health Organization Retrieved 20 July 2020 Diagnostic and statistical manual of mental disorders DSM 5 5th ed Arlington VA American Psychiatric Association 2013 p 31 ISBN 9780890425541 Stein DJ December 2013 What is a mental disorder A perspective from cognitive affective science Canadian Journal of Psychiatry 58 12 656 62 doi 10 1177 070674371305801202 PMID 24331284 Stein DJ Phillips KA Bolton D Fulford KW Sadler JZ Kendler KS November 2010 What is a mental psychiatric disorder From DSM IV to DSM V Psychological Medicine 40 11 1759 65 doi 10 1017 S0033291709992261 OCLC 01588231 PMC 3101504 PMID 20624327 In DSM IV each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress e g a painful symptom or disability i e impairment in one or more important areas of functioning or with a significantly increased risk of suffering death pain disability or an important loss of freedom In addition this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event for example the death of a loved one Whatever its original cause it must currently be considered a manifestation of behavioral psychological or biological dysfunction in the individual Neither deviant behavior e g political religious or sexual nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual as described above Stein DJ Phillips KA Bolton D Fulford KW Sadler JZ Kendler KS November 2010 What is a mental psychiatric disorder From DSM IV to DSM V Psychological Medicine 40 11 1759 65 doi 10 1017 S0033291709992261 OCLC 01588231 PMC 3101504 PMID 20624327 Stein DJ Phillips KA Bolton D Fulford KW Sadler JZ Kendler KS November 2010 What is a mental psychiatric disorder From DSM IV to DSM V Psychological Medicine 40 11 1759 65 doi 10 1017 S0033291709992261 OCLC 01588231 PMC 3101504 PMID 20624327 although this manual provides a classification of mental disorders it must be admitted that no definition adequately specifies precise boundaries for the concept of mental disorder The concept of mental disorder like many other concepts in medicine and science lacks a consistent operational definition that covers all situations All medical conditions are defined on various levels of abstraction for example structural pathology e g ulcerative colitis symptom presentation e g migraine deviance from a physiological norm e g hypertension and etiology e g pneumococcal pneumonia Mental disorders have also been defined by a variety of concepts e g distress dyscontrol disadvantage disability inflexibility irrationality syndromal pattern 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139 51 doi 10 1097 01 JNR 0000347572 60800 00 PMID 11779087 Logdberg B Nilsson LL Levander MT Levander S August 2004 Schizophrenia neighbourhood and crime Acta Psychiatrica Scandinavica 110 2 92 7 doi 10 1111 j 1600 0047 2004 00322 x PMID 15233709 S2CID 12605241 Westerhof Gerben J Keyes Corey L M June 2010 Mental Illness and Mental Health The Two Continua Model Across the Lifespan Journal of Adult Development 17 2 110 119 doi 10 1007 s10804 009 9082 y ISSN 1068 0667 PMC 2866965 PMID 20502508 What is Mental Health and Mental Illness Workplace Mental Health Promotion Workplace Mental Health Promotion a b c Brune M Brune Cohrs U McGrew WC Preuschoft S 2006 Psychopathology in great apes concepts treatment options and possible homologies to human psychiatric disorders Neuroscience and Biobehavioral Reviews 30 8 1246 59 doi 10 1016 j neubiorev 2006 09 002 PMID 17141312 S2CID 10101196 Ferdowsian HR Durham DL Kimwele C Kranendonk G Otali E Akugizibwe T et al 2011 Callaerts P ed Signs of mood and anxiety disorders in chimpanzees PLOS ONE 6 6 e19855 Bibcode 2011PLoSO 619855F doi 10 1371 journal pone 0019855 PMC 3116818 PMID 21698223 Fabrega H 2006 Making sense of behavioral irregularities of great apes Neuroscience and Biobehavioral Reviews 30 8 1260 73 discussion 1274 7 doi 10 1016 j neubiorev 2006 09 004 PMID 17079015 S2CID 20587935 Lilienfeld SO Gershon J Duke M Marino L de Waal FB December 1999 A preliminary investigation of the construct of psychopathic personality psychopathy in chimpanzees Pan troglodytes Journal of Comparative Psychology 113 4 365 75 doi 10 1037 0735 7036 113 4 365 PMID 10608560 Moran M 20 June 2003 Animals Can Model Psychiatric Symptoms Psychiatric News 38 12 20 30 doi 10 1176 pn 38 12 0020 Sanchez MM Ladd CO Plotsky PM 2001 Early adverse experience as a developmental risk factor for later psychopathology evidence from rodent and primate models Development and Psychopathology 13 3 419 49 doi 10 1017 S0954579401003029 PMID 11523842 S2CID 25469071 Matthews K Christmas D Swan J Sorrell E 2005 Animal models of depression navigating through the clinical fog Neuroscience and Biobehavioral Reviews 29 4 5 503 13 doi 10 1016 j neubiorev 2005 03 005 PMID 15925695 S2CID 23468566 Further readingAtkinson J 2006 Private and Public Protection Civil Mental Health Legislation Edinburgh Dunedin Academic Press ISBN 978 1 903765 61 6 Hockenbury D Hockenbury S 2004 Discovering Psychology Worth Publishers ISBN 978 0 7167 5704 7 Fried Y Agassi J 1976 Paranoia A Study in Diagnosis Boston Studies in the Philosophy of Science 50 ISBN 978 90 277 0704 8 publisher missing Fried Y Agassi J 1983 Psychiatry as Medicine The Hague Nijhoff ISBN 978 90 247 2837 4 National Academies of Sciences Engineering and Medicine 2016 Ending Discrimination Against People with Mental and Substance Use Disorders The Evidence for Stigma Change Washington DC National Academies Press doi 10 17226 23442 ISBN 978 0 309 43912 1 PMID 27631043 Porter R 2002 Madness a brief history Oxford Oxfordshire Oxford University Press ISBN 978 0 19 280266 8 Weller MP Eysenck M 1992 The Scientific Basis of Psychiatry London W B Saunders ISBN missing Wiencke M 2006 Schizophrenie als Ergebnis von Wechselwirkungen Georg Simmels Individualitatskonzept in der Klinischen Psychologie In Kim D ed Georg Simmel in Translation Interdisciplinary Border Crossings in Culture and Modernity Cambridge Cambridge Scholars Press pp 123 55 ISBN 978 1 84718 060 5 Radden J 20 February 2019 Mental Disorder Illness Stanford Encyclopedia of Philosophy Management of physical health conditions in adults with severe mental disorders PDF WHO 2018 ISBN 978 92 4 155038 3 External linksClassificationDICD 10 F99ICD 9 CM 290 319MeSH D001523DiseasesDB 28852Wikimedia Commons has media related to Mental and behavioural diseases and disorders Wikivoyage has a travel guide for Travelling with a mental health condition Listen to this article 12 minutes source source This audio file was created from a revision of this article dated 20 August 2005 2005 08 20 and does not reflect subsequent edits Audio help More spoken articles NIMH NIH gov National Institute of Mental Health International Committee of Women Leaders on Mental Health Retrieved from https en wikipedia org w index php title Mental disorder amp oldid 1053942556 Stigma, wikipedia, wiki, book,

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