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 a single episode.
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.
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 psychiatrists, psychologists, 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.
psychiatric medication are two major treatment options. Other
treatments include 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
Common mental disorders include depression, which affects about 400
million, dementia which affects about 35 million, and schizophrenia,
which affects about 21 million people globally. 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.
2.1 Dimensional models
4 Signs and symptoms
10.1 Ancient civilizations
10.2.1 Middle Ages
10.2.2 Eighteenth century
10.2.3 Nineteenth century
10.2.4 Twentieth century
10.3 Europe and the United States
Society and culture
11.3 Cultural bias
11.4 Laws and policies
11.5 Perception and discrimination
11.5.2 Media and general public
12 Mental health
13 Other animals
14 See also
16 Further reading
17 External links
The examples and perspective in this section deal primarily with North
America and do not represent a worldwide view of the subject. You may
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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 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
DSM-IV precedes 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
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
Main article: Classification of mental disorders
There are currently two widely established systems that classify
ICD-10 Chapter V: Mental and behavioural disorders, since 1949 part of
International Classification of Diseases produced by the WHO,
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
produced by the
American Psychiatric Association
American Psychiatric Association (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, for example 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
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.
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 abuse 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.
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
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.
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.[non-primary source needed]
Patterns of belief, language use and perception of reality can become
disordered (e.g., delusions, thought disorder, hallucinations).
Psychotic disorders in this domain include schizophrenia, and
Schizoaffective disorder is a category used for
individuals showing aspects of both schizophrenia and affective
Schizotypy is a category used for individuals showing some
of the characteristics associated with schizophrenia but without
meeting cutoff criteria.
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. The 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 so-called "personality disorders", like
personality traits in general, actually 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
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 disorders such as insomnia involve disruption to normal sleep
patterns, or a feeling of tiredness despite sleep appearing normal.
Sexual disorders and gender dysphoria may be diagnosed, including
dyspareunia and ego-dystonic homosexuality. Various kinds of
paraphilia are considered mental disorders (sexual arousal to objects,
situations, or individuals that are considered abnormal or harmful to
the person or others).
People who are abnormally unable to resist certain urges or impulses
that could be harmful to themselves or others, may be classed 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
The use of drugs (legal or illegal, including alcohol), when it
persists despite significant problems related to its use, may be
defined as a mental disorder. The DSM incorporates such conditions
under the umbrella category of substance use disorders, which includes
substance dependence and substance abuse. The DSM does not currently
use the common term drug addiction, and the ICD simply refers to
"harmful use". Disordered substance use may be due to a pattern of
compulsive and repetitive use of the drug that results in tolerance to
its effects and withdrawal symptoms when use is reduced or stopped.
People who suffer severe disturbances of their self-identity, memory
and general awareness of themselves and their surroundings may be
classed as having a dissociative identity disorder, such as
depersonalization disorder or Dissociative Identity Disorder itself
(which has also been called multiple personality disorder, or "split
personality"). Other memory or cognitive disorders include amnesia or
various kinds of old age dementia.
A range of developmental disorders that initially occur in childhood
may be diagnosed, for example autism spectrum disorders, 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). Popularist 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, such as Munchausen syndrome, are diagnosed where
symptoms are thought to be experienced (deliberately produced) and/or
reported (feigned) for personal gain.
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 diagnosis 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 and premenstrual dysphoric
Two recent unique unofficial proposals are solastalgia by Glenn
Albrecht and hubris syndrome by David Owen. The application of the
concept of mental illness to the phenomena described by these authors
has in turn been critiqued by Seamus Mac Suibhne.
Signs and symptoms
The likely course and outcome of mental disorders varies and is
dependent on numerous factors related to the disorder itself, the
individual as a whole, and the social environment. Some disorders are
transient, while others may be more chronic in nature.
Even those disorders often considered the most serious and intractable
have varied courses i.e. schizophrenia, psychotic disorders, and
personality disorders. 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 some requiring no medication. At the same time,
many have serious difficulties and support needs for many years,
although "late" recovery is still possible. 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]
Around half of people initially diagnosed with bipolar disorder
achieve syndromal 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. However, nearly half go on to
experience a new episode of mania or major depression within the next
two years.[non-primary source needed] Functioning has been found
to vary, being poor during periods of major depression or mania but
otherwise fair to good, and possibly superior during periods of
hypomania in Bipolar II.[non-primary source needed]
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
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 a job 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
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 total DALY does not necessarily indicate what
is the most individually disabling because it also depends on how
common a condition is; for example, schizophrenia is found to be the
most individually disabling mental disorder on average but is less
common. Alcohol-use disorders are also high in the overall list,
responsible for 23.7 million DALYs globally, while other drug-use
disorders accounted for 8.4 million.
Schizophrenia causes a total loss
of 16.8 million DALY, and bipolar disorder 14.4 million. Panic
disorder leads to 7 million years lost, obsessive-compulsive disorder
5.1, primary insomnia 3.6, and post-traumatic stress disorder 3.5
The first ever systematic description of global disability arising in
youth, published 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 disability 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.
Main article: Causes of mental disorders
Risk factors for mental illness include genetic inheritance, such as
parents having depression, or a propensity for high neuroticism
 or "emotional instability".
In depression, parenting risk factors include parental unequal
treatment, and there is association with high cannabis use.
In schizophrenia and psychosis, risk factors include migration and
discrimination, childhood trauma, bereavement or separation in
families, and abuse of drugs, including cannabis, and
In anxiety, risk factors may include family history (e.g. of anxiety),
temperament and attitudes (e.g. pessimism), and 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).
Environmental events surrounding pregnancy and birth have also been
Traumatic brain injury
Traumatic brain injury may increase the risk of developing
certain mental disorders. There have been some tentative inconsistent
links found to certain viral infections, to substance misuse, and to
general physical health.
Social influences have been found to be important, including
abuse, neglect, bullying, social stress, traumatic events and other
negative or overwhelming life experiences. 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. The specific risks and pathways
to particular disorders are less clear, however. 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
Correlations of mental disorders with drug use include 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
This section needs expansion. You can help by adding to it. (April
Although researchers have been looking for decades for clear linkages
between genetics and mental disorders to provide better diagnosis and
facilitate the development of better treatments, that work has yielded
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 disorder may be viewed as primarily
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
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
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.
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 patient’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
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
Main 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." 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
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.
Main articles: Treatment of mental disorders, Services for mental
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 is provided in psychiatric
hospitals, clinics or any of a diverse range of community mental
health services. A number of professions have developed that
specialize in the treatment of mental disorders. This includes the
medical specialty of psychiatry (including psychiatric
nursing), the field of psychology known as clinical
psychology, and the practical application of sociology known as
social work. 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. The different clinical and scientific
perspectives draw on diverse fields of research and theory, and
different disciplines may favor differing models, explanations and
In some countries services are increasingly based on a recovery
approach, intended to support each individual's personal journey to
gain the kind of life they want, although there may also be
'therapeutic pessimism' in some areas.
There are a range of different types of treatment and what is most
suitable depends on the disorder and on 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
Compulsory treatment while in the community versus non-compulsory
treatment does not appear to make much of a difference except by maybe
A major option for many mental disorders is psychotherapy. There are
several main types.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is widely used
and is based on modifying the patterns of thought and behavior
associated with a particular disorder. 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 a
number of 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.
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.
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.
Electroconvulsive therapy (ECT) is sometimes used in severe cases when
other interventions for severe intractable depression have failed.
Psychosurgery is considered experimental but is advocated by some
neurologists in certain rare cases.
Counseling (professional) and co-counseling (between peers) may be
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.
Main article: Prevalence of mental disorders
Deaths from mental and behavioral disorders per million persons in
Disability-adjusted life year
Disability-adjusted life year for neuropsychiatric conditions per
100,000 inhabitants in 2004.
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
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
DSM-IV disorders assessed, which included mood disorders
(13.9%), anxiety disorders (13.6%) or alcohol disorder (5.2%).
Approximately one in ten met criteria within a 12-month period. Women
and younger people of either gender showed more cases of
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
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
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Main article: History of mental disorders
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,
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.
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. At the turn of the
16th and 17th centuries, the mentally ill were increasingly admitted
to local workhouses, jails and private madhouses by social justice
advocates such as Dorothea Dix. Many terms for mental disorder
that found their way into everyday use first became popular in the
16th and 17th centuries.
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 prior to the 19th 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
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 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
World War I saw a
massive increase of conditions that came to be termed "shell shock".
World War II
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 (DSM). 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
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 behavioural 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
Cognitive behavioral therapy
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
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
Psychology of 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.
Controversy has often surrounded psychiatry, and the term
anti-psychiatry was coined by 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
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'.
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
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
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
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.
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 utilized 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
In order 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
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 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
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
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
Schizophrenogenic parents and Refrigerator mother
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." 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]
Efforts are being undertaken worldwide to eliminate the stigma of
mental illness, although the methods and outcomes used have
sometimes been criticized.
A 2008 study by
Baylor University researchers found that clergy in the
US often deny or dismiss the existence of a mental illness. Of 293
Christian church members, more than 32 percent were told by their
church pastor that they or their loved one did not really have a
mental illness, and that the cause of their problem was solely
spiritual in nature, such as a personal sin, lack of faith or demonic
involvement. The researchers also found that women were more likely
than men to get this response. All participants in both studies were
previously diagnosed by a licensed mental health provider as having a
serious mental illness.[non-primary source needed] However, there
is also research suggesting that people are often helped by extended
families and supportive religious leaders who listen with kindness and
respect, which can often contrast with usual practice in psychiatric
diagnosis and medication.[unreliable medical source?]
The mentally ill are stigmatized in Chinese society and can not
legally marry. Recently more studies are being conducted to show
how being stigmatized effects the care and treatment mental health
Participatory action research
Participatory action research is a method now being
used to help understand how young people in particular are being
effected by their diagnosis. One study conducted by, School of Health
and Human Sciences,
University of Essex
University of Essex showed that males and females
had a hard time telling their friends about their recent diagnosis and
felt alienated. Most of them, however felt that the experience allowed
them to open their minds to the idea of needing mental help.
Doctors and therapist also play a role in helping patients to learn to
cope with the possibility of being stigmatized. In order to improve
their quality of life the people involved in the patient's care must
make them aware that stigmas may arise and prepare them for the
reality of being diagnosed with a serious mental illness. Yet another
study was conducted in which 101 participants diagnosed with a serious
mental illness were monitored for a year, some patients were
socialized with the intent to teach them about stigmas and how to cope
and others were not. The results showed that those participants that
were socialized fared better in daily activities such as work and
school and they also responded to treatment better than those who were
not exposed to the socialization. Based on the most recent
research from 2012–2013, children and adolescents have been widely
reporting to face problems with peer relationships due to the
diagnosis of a mental illness. They face isolation and ridicule from
Stereotypes that are associated with their diagnosis also do
not go unnoticed, many of them face bullying simply due to the fact
that they have
ADHD or depression. This hinders their chance for a
fast recovery and may even prevent them from seeking further
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. 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
Iron Man 3
Iron Man 3 (2013).[original research?]
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 abuse 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
abuse (including alcoholism) to which some people may be particularly
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 Organisation
World Health Organisation (WHO), over
a third of people in most countries report problems at some time in
their life which meet criteria for diagnosis of one or more of the
common types of mental disorder.
Mental health can be defined as
an absence of mental disorder.
Main 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
The risk of anthropomorphism is often raised with regard to 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
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 care-giving is often not
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.
Mental illness portrayed in media
Mental illness in American prisons
National Institute of Mental Health
Parity of esteem
^ "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, Derek (2008). What is Mental Disorder?: An Essay in
Philosophy, Science, and Values. OUP Oxford. p. 6.
^ a b c d "Mental disorders". World Health Organisation. October 2014.
Archived from the original on 18 May 2015. Retrieved 13 May
^ "Mental disorders". World Health Organization. Archived from the
original on 29 March 2016. Retrieved 9 April 2016.
^ American Psychiatric Association. Diagnostic and Statistical Manual
of Mental Disorders (5th ed.). Arlington: American Psychiatric
Publishing. pp. 101–5. ISBN 978-0-89042-555-8.
^ Stein, Dan J. (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. Archived from the original (PDF) on
^ Stein, Dan J; Phillips, K.A; Bolton, D; Fulford, K.W.M; Sadler, J.Z;
Kendler, K.S (November 2010). "What is a Mental/Psychiatric Disorder?
DSM-IV to DSM-V". Psychological Medicine. London: Cambridge
University Press. 40 (11): 1759–1765. doi:10.1017/S0033291709992261.
ISSN 0033-2917. 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 a 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, Dan J; Phillips, K.A; Bolton, D; Fulford, K.W.M; Sadler, J.Z;
Kendler, K.S (November 2010). "What is a Mental/Psychiatric Disorder?
DSM-IV to DSM-V : Table 1
DSM-IV Definition of Mental
Disorder". Psychological Medicine. London: Cambridge University Press.
40 (11): 1759–1765. doi:10.1017/S0033291709992261.
ISSN 0033-2917. OCLC 01588231. PMC 3101504 .
^ Stein, Dan J; Phillips, K.A; Bolton, D; Fulford, K.W.M; Sadler, J.Z;
Kendler, K.S (November 2010). "What is a Mental/Psychiatric Disorder?
DSM-IV to DSM-V". Psychological Medicine. London: Cambridge
University Press. 40 (11): 1759–1765. doi:10.1017/S0033291709992261.
ISSN 0033-2917. 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
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Mental and behavioral disorders (F00–F99 & 290–319)
Mild cognitive impairment
AIDS dementia complex
Organic brain syndrome
Psychoactive substances, substance abuse, drug abuse and
Schizophrenia, schizotypal and delusional
Psychosis and schizophrenia-like disorders
Brief reactive psychosis
Disorganized (hebephrenic) schizophrenia
Folie à deux
(Major depressive disorder
Seasonal affective disorder
Neurotic, stress-related and somatoform
Specific social phobia
Generalized anxiety disorder
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Adjustment disorder with depressed mood
Body dysmorphic disorder
Da Costa's syndrome
Mass psychogenic illness
Dissociative identity disorder
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(Female sexual arousal disorder)
Adult personality and behavior
Sexual maturation disorder
Ego-dystonic sexual orientation
Sexual relationship disorder
Impulse control disorder
Disorders typically diagnosed in childhood
X-linked intellectual disability
Emotional and behavioral
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Symptoms and uncategorized
Intermittent explosive disorder
Psychogenic non-epileptic seizures