At least conceptually, psychopathology is a subset of pathology, which is the "... scientific study of the nature of disease and its causes, processes, development, and consequences." Psychopathology is distinct from psychiatry by virtue of being a theoretical field of scientific research rather than a specialty of medical practice.
History
Early explanations for mental illnesses were influenced by religious belief and superstition.
Psychological conditions that are now classified as mental disorders
were initially attributed to possessions by evil spirits, demons, and
the devil. This idea was widely accepted up until the sixteenth and
seventeenth centuries. Individuals who suffered from these so-called
"possessions" were tortured as treatment.
Doctors used this technique in hoping to bring their patients back to
sanity. Those who failed to return to sanity after torture were
executed.
The Greek physician Hippocrates
was one of the first to reject the idea that mental disorders were
caused by possession of demons or the devil. He firmly believed the
symptoms of mental disorders were due to diseases originating in the
brain. Hippocrates suspected that these states of insanity were due to
imbalances of fluids in the body. He identified these fluids to be four
in particular: blood, black bile, yellow bile, and phlegm.
Furthermore, not far from Hippocrates, the philosopher Plato
would come to argue the mind, body, and spirit worked as a unit. Any
imbalance brought to these compositions of the individual could bring
distress or lack of harmony within the individual. This philosophical
idea would remain in perspective until the seventeenth century.
In the eighteenth century's Romantic Movement, the idea that
healthy parent-child relationships provided sanity became a prominent
idea. Philosopher Jean-Jacques Rousseau introduced the notion that trauma in childhood could have negative implications later in adulthood.
In the nineteenth century, greatly influenced by Rousseau's ideas and philosophy, Austrian psychoanalyst Sigmund Freud
would bring about psychotherapy and become the father of
psychoanalysis, a clinical method for treating psychopathology through
dialogue between a patient and a psychoanalyst. Talking therapy would
originate from his ideas on the individual's experiences and the natural
human efforts to make sense of the world and life.
As the study of psychiatric disorders
The scientific discipline of psychopathology was founded by Karl Jaspers
in 1913. It was referred to as "static understanding" and its purpose
was to graphically recreate the "mental phenomenon" experienced by the
client.
The study of psychopathology is interdisciplinary, with
contributions coming from clinical, social, and developmental
psychology, as well as neuropsychology and other psychology
subdisciplines; psychiatry; neuroscience generally; criminology; social
work; sociology; epidemiology; statistics; and more. Practitioners in clinical and academic fields are referred to as psychopathologists.
How do scientists (and people in general) distinguish between unusual or odd behavior on one hand, and a mental disorder on the other? One strategy is to assess a person along four dimensions: deviance, distress, dysfunction. and danger, known collectively as the Four D's.
The four Ds
A description of the four Ds when defining abnormality:
- Deviance: this term describes the idea that specific thoughts, behaviours and emotions are considered deviant when they are unacceptable or not common in society. Clinicians must, however, remember that minority groups are not always deemed deviant just because they may not have anything in common with other groups. Therefore, we define an individual's actions as deviant or abnormal when their behaviour is deemed unacceptable by the culture they belong to. However, many disorders have a relation between patterns of deviance and therefore need to be evaluated in a differential diagnostic model.
- Distress: this term accounts for negative feelings by the individual with the disorder. They may feel deeply troubled and affected by their illness. Behaviors and feelings that cause distress to the individual or to others around him or her are considered abnormal, if the condition is upsetting to the person experiencing it. Distress is related to dysfunction by being a useful asset in accurately perceiving dysfunction in an individual’s life. These two are not always related because an individual can be highly dysfunctional and at the same time experiencing minimal stress. One should know the important characteristic of distress is not involved with dysfunction, but rather the limit to which an individual is stressed by an issue.
- Dysfunction: this term involves maladaptive behaviour that impairs the individual's ability to perform normal daily functions, such as getting ready for work in the morning, or driving a car. This maladaptive behaviour has to be a problem large enough to be considered a diagnosis. It's highly noted to look for dysfunction across an individual's life experience because there is a chance the dysfunction may appear in clear observable view and in places where it is less likely to appear. Such maladaptive behaviours prevent the individual from living a normal, healthy lifestyle. However, dysfunctional behaviour is not always caused by a disorder; it may be voluntary, such as engaging in a hunger strike.
- Danger: this term involves dangerous or violent behaviour directed at the individual, or others in the environment. The two important characteristics of danger is, danger to self and danger to others. When diagnosing, there is a large vulnerability of danger in which there is some danger in each diagnosis and within these diagnoses there is a continuum of severity. An example of dangerous behaviour that may suggest a psychological disorder is engaging in suicidal activity. Behaviors and feelings that are potentially harmful to an individual or the individuals around them are seen as abnormal.
The p factor
Instead of conceptualizing psychopathology as consisting of several
discrete categories of mental disorders, groups of psychological and
psychiatric scientists have proposed a "general psychopathology"
construct, named the p-factor, because of its conceptual similarity with
the g factor of general intelligence.
Although researchers initially conceived a tripartite (three factor)
explanation for psychopathology generally, subsequent study provided
more evidence for a unitary, factor that is sequentially comorbid,
recurrent/chronic, and exists on a continuum of severity and chronicity.
Thus, the p factor is a dimensional, as opposed to a categorical,
construct.
Higher scores on the p factor dimension have been found to be
correlated with higher levels of functional impairment, greater
incidence of problems in developmental history, and more diminished
early-life brain function. In addition, those with higher levels of the p
factor are more likely to have inherited a genetic predisposition
to mental illness. The existence of the p factor may explain why it has
been "... challenging to find causes, consequences, biomarkers, and
treatments with specificity to individual mental disorders."
The p factor has been likened to the g factor of general intelligence,
which is also a dimensional system by which overall cognitive ability
can be defined. As psychopathology has typically been studied and
implemented as a categorical system, like the Diagnostic and Statistical Manual
system developed for clinicians, the dimensional system of the p factor
provides an alternative conceptualization of mental disorders that
might improve our understanding of psychopathology in general; lead to
more precise diagnoses; and facilitate more effective treatment
approaches.
Benjamin Lahey and colleagues first proposed a general psychopathology factor in 2012.
As mental symptoms
The term psychopathology
may also be used to denote behaviors or experiences which are
indicative of mental illness, even if they do not constitute a formal
diagnosis. For example, the presence of a hallucination
may be considered as a psychopathological sign, even if there are not
enough symptoms present to fulfill the criteria for one of the disorders
listed in the DSM or ICD.
In a more general sense, any behaviour or experience which causes impairment, distress or disability, particularly if it is thought to arise from a functional breakdown in either the cognitive or neurocognitive
systems in the brain, may be classified as psychopathology. It remains
unclear how strong the distinction between maladaptive traits and mental
disorders actually is, e.g. neuroticism is often described as the personal level of minor psychiatric symptoms.
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders
(DSM) is an guideline for the diagnosis and understanding of mental
disorders. It serves as reference for a range of professionals in
medicine and mental health in the United States particularly. These
professionals include psychologists, counselors, physicians, social
workers, psychiatric nurses and nurse practitioners, marriage and family
therapists, and more.
Examples of mental disorders classified within the DSM include:
- Major depressive disorder is a mood disorder defined by symptoms of loss of motivation, decreased mood, lack of energy and thoughts of suicide.
- Bipolar disorders are mood disorders characterized by depressive and manic episodes of varying lengths and degrees.
- Dysthymia is a mood disorder similar to depression. Characterized by a persistent low mood, dysthymia is a less debilitating form of depression with no break in ordinary functioning.
- Schizophrenia is characterized by altered perception of reality, including delusional thoughts, hallucinations, and disorganized speech and behaviour. Most cases arise in patients in their late teens or early adulthood, but can also appear later on in life.
- Borderline personality disorder occurs in early adulthood for most patients; specific symptoms include patterns of unstable and intense relationships, chronic feelings of emptiness, emotional instability, paranoid thoughts, intense episodes of anger, and suicidal behavior.
- Bulimia nervosa "binge and purge", an eating disorder specified as reoccurring episodes of uncontrollable binge eating followed by a need to vomit, take laxatives, or exercise excessively. Usually begins occurring at adolescence but most individuals do not seek help until later in life when it can be harder to change their eating habits.
- Phobias Found in people of all ages. Characterized by an abnormal response to fear or danger. Persons diagnosed with Phobias suffer from feelings of terror and uncontrollable fear, exaggerated reactions to danger that in reality is not life-threatening, and is usually accompanied by physical reactions related to extreme fear: panic, rapid heartbeat, and/or shortened breathing.
- Pyromania this disorder is indicated by fascination, curiosity, or attraction to purposely setting things on fire. Pyromaniacs find pleasure and/or relief by watching things burn. Can occur due to delusional thinking, impaired judgement due to other mental disorders, or simply as aggressive behavior to express anger.
DSM/RDoc debate
Some scholars have argued that field should switch from the DSM categorical approach of mental disorders to the Research Domain Criteria
(RDoC) dimensional approach of mental disorders, although the consensus
at present is to retain DSM for treatment, insurance, and related
purposes, while emphasizing RDoC conceptualizations for planning and
funding psychiatric research.
