Section Learning Objectives

• Define psychopathology and psychological disorders.
• Explain the concept of psychological dysfunction as it relates to psychological disorders.
• Explain the concepts of distress and impairment as they relate to psychological disorders.
• Explain the concept of deviance as it relates to psychological disorders.
• Identify and describe the various types of mental health professionals.

1.1.1 Definition of Psychopathology

The term psychopathology refers to the scientific study of psychological disorders, with the intent to be able to reliably predict, explain, diagnose, identify the causes of, and treat these disorders. This definition begs the question of, what is considered a psychological disorder (aka a mental disorder)?

1.1.2. Defining Psychological Disorders

It may be surprising to you, but the concept of psychological disorders has proven very difficult to define and even the American Psychiatric Association (APA, 2013), in its most recent publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition text revision (DSM-5-TR for short), states that “although no definition can capture all aspects of the range of all disorders contained in the DSM-5” certain aspects are required. While the concept of psychological disorders is difficult to define, and no definition will ever be perfect, it is recognized as an extremely important concept and therefore psychological disorders (aka mental disorders) have been defined as a psychological dysfunction that causes distress or impaired functioning and that is atypical or unexpected according to societal or cultural standards. This definition includes three components. Let’s break these down now:

• Dysfunction – Clinically significant disturbance in an individual’s cognition, emotion, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. In other words, dysfunction refers to a breakdown in cognition, emotion, and/or behavior. For instance, an individual experiencing delusions that he is an omnipotent deity would have a breakdown in cognition because his thought processes are not consistent with reality. An individual who is unable to experience pleasure even when something wonderful happens would have a breakdown in emotion. Finally, an individual who is unable to leave her home and attend work due to fear of having a panic attack would be exhibiting a breakdown in behavior. Dysfunctions in behavior have the capacity to impair functioning and can be assessed by looking at an individual’s current performance and comparing it to what is expected in general or how the person has performed in the past.
• Distress or Impairment –  Distress can take the form of psychological or physical pain, or both concurrently. Simply put, distress refers to suffering. Alone though, distress is not sufficient enough to warrant the diagnosis of a psychological disorder. Why is that? The loss of a loved one would cause even the most highly functioning individual pain and suffering. An athlete who experiences a career-ending injury would display distress as well. Suffering is part of life and cannot be avoided. And some people who are diagnosed with psychological disorders don’t report distress (e.g., someone experiencing a manic episode may feel euphoric, not distressed). Typically, if distress is absent then impairment must be present to diagnose a psychological disorder. Impairment refers to when the person experiences a disabling condition in social, occupational, or other important activities. In other words, impairment refers to when a person loses the capacity to function normally in daily life (e.g., can no longer maintain minimum standards of hygiene, pay bills, attend social functions, or go to work). Once again typically distress and/or impairment in functioning are required to diagnose a psychological disorder.
• Atypical or Not Culturally Expected – Our culture – or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group – determines what is considered “normal” or “atypical” and so a person is said to exhibit atypical behavior when they fail to follow the stated and unstated rules of society, called social norms. What is considered atypical by society can change over time due to shifts in accepted values and expectations. For instance, just a few decades ago homosexuality was considered taboo in the U.S. and it was included as a psychological disorder in the first edition of the DSM; but we have grown as a society so today homosexuality is generally accepted. Likewise, public displays of affection (PDA), do not cause a second look by most people unlike in the past when these outward expressions of love were restricted to the privacy of one’s own house or bedroom. Finally, consider that statistically atypical behavior is not necessarily negative. Being a genius is an example of something that is atypical but that is viewed as positive and desirable.

1.1.3. What is the Cost of Psychological Disorders to Society?

This leads us to consider the cost of psychological disorders to society. The National Alliance on Mental Illness (NAMI) indicates that depression is the number one cause of disability across the world “and is a major contributor to the global burden of disease.” Serious mental illness costs the United States an estimated $193 billion in lost earnings each year. They also point out that suicide is the 10th leading cause of death in the U.S. and 90% of those who die from suicide have an underlying psychological disorder. In relation to children and teens, 37% of students with a psychological disorder at age 14+ drop out of school which is the highest dropout rate of any disability group, and 70% of youth in state and local juvenile justice systems have at least one psychological disorder. Source: https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers. In terms of worldwide impact, the World Economic Forum used 2010 data to estimate $2.5 trillion in global costs in 2010 and projected costs of $6 trillion by 2030. The costs of mental illness are greater than the combined costs of cancer, diabetes, and respiratory disorders (Whiteford et al., 2013). And finally, “The Social Security Administration reports that in 2012, 2.6 and 2.7 million people under age 65 with mental illness-related disability received SSI and SSDI payments, respectively, which represents 43 and 27 percent of the total number of people receiving such support, respectively” (Source: https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mental-health-awareness-month-by-the-numbers.shtml). So as you can see the cost of psychological disorders is quite staggering for the United States and other countries.

In conclusion, though there is no one factor that we can use to classify people with psychological disorders, most clinical practitioners agree that when behavior strays from what is considered the cultural norm; when there is dysfunction in cognition, emotion, and/or behavior; and when the individual experiences distress and/or impairment in functioning as a consequence, they likely are experiencing a psychological disorder.

1.1.4. Types of Mental Health Professionals

There are many types of mental health professionals that people may seek out for assistance. They include:

Table 1: Types of Mental Health Professionals

1.1.4.1. Prescription Rights for Psychologists

To reduce inappropriate and over-prescribing it has been proposed to allow appropriately trained psychologists the right to prescribe. Psychologists are more likely to choose between therapy and medications, and so can make the best choice for their patients. The right has already been granted in New Mexico, Louisiana, Guam, the military, the Indian Health Services, and the U.S. Public Health Services. Measures in other states “have been opposed by the American Medical Association and American Psychiatric Association over concerns that inadequate training of psychologists could jeopardize patient safety. Supporters of prescriptive authority for psychologists are quick to point out that there is no evidence to support these concerns (Smith, 2012).”

For more information on types of mental health professionals, please visit:

http://www.mentalhealthamerica.net/types-mental-health-professionals