Psychological Disorders

Defining Mental Illness

Psychological disorders are patterns of thoughts, feelings, or behaviors that are deviant, distressing, dysfunctional, or dangerous. The distinction between normal struggles and mental illness is often debated, with criteria including maladaptiveness, personal discomfort, and impairment in daily functioning. The DSM-5 defines mental disorders as patterns that cause distress, impair functioning, or increase risk of harm. However, not all individuals with mental illness are maladaptive (e.g., narcissistic personality disorder).

• Maladaptive behavior: Interferes with daily life and well-being.

• Deviance: Unusual or atypical behaviors.

• Distress: Causes significant personal suffering.

• Danger: Increases risk of harm to self or others.

Historical Conceptions of Mental Illness

Views on mental illness have evolved from supernatural explanations to medical models:

• Demonic Model (Middle Ages): Odd behaviors attributed to evil spirits; treatments included exorcisms and witch hunts.

• Medical Model (Renaissance): Mental illness seen as a physical disorder; asylums established but often overcrowded and inhumane.

• Moral Treatment (1700s–1800s): Reformers like Phillipe Pinel and Dorothea Dix advocated for humane treatment, dignity, and respect for patients.

Modern Era and Deinstitutionalization

The development of antipsychotic medications (e.g., chlorpromazine) in the 1950s led to deinstitutionalization in the 1960s–70s. While this allowed many patients to leave hospitals, community support was often lacking, resulting in mixed outcomes.

Diagnosis Across Cultures

Some psychological disorders are universal (e.g., schizophrenia, alcoholism), while others are culture-bound syndromes. Culture influences the expression and interpretation of symptoms.

• Malocchio: Italian folk belief attributing anxiety and bad luck to envy.

• Taijin Kyofusho (TKS): Japanese social anxiety focused on offending others, reflecting collectivist values.

Classification and Diagnosis: The DSM

The DSM System

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the official classification system for mental disorders in North America. It provides diagnostic criteria, decision rules, and prevalence information. The DSM has expanded significantly since its first edition in 1952.

Supporters argue that the DSM improves diagnostic reliability and communication among clinicians. Critics claim it may lead to overdiagnosis and overtreatment, sometimes driven by insurance requirements.

Biopsychosocial Model

This model considers biological, psychological, and social factors in understanding mental disorders:

• Biological: Brain chemistry, genetics, neurodevelopment, physical health.

• Psychological: Cognitive patterns, emotional regulation, personality, coping skills.

• Social: Environment, culture, family, socioeconomic status.

Prevalence and Trends in Mental Disorders

Mental disorders are common and their prevalence can change over time. For example, rates of major depressive episodes, bipolar disorder, and anxiety disorders have increased in Canada over the past decade.

Specific Psychological Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD is a developmental disorder characterized by inappropriate levels of hyperactivity, impulsivity, and inattention. Diagnosis requires at least six symptoms of inattention or hyperactivity/impulsivity. Treatment includes behavioral therapies and medications. Prevalence has increased significantly in North America.

Anxiety-Related Disorders

These disorders involve excessive, persistent anxiety or maladaptive behaviors to reduce anxiety. Types include:

• Generalized Anxiety Disorder (GAD): Chronic worry, tension, and irritability about many areas of life.

• Panic Disorder: Recurrent, unexpected panic attacks and persistent concern about future attacks.

• Phobias: Unrealistic fear of specific situations or objects (e.g., agoraphobia).

• Obsessive-Compulsive Disorder (OCD): Intrusive obsessions and ritualistic compulsions.

• OCD-Related Disorders: Hoarding, excoriation, trichotillomania, body dysmorphic disorder.

Mood Disorders

Mood disorders include depression and bipolar disorder, affecting nearly 10% of adults in North America. Depression is more common in women and those living in poverty.

• Major Depression: Persistent sadness, hopelessness, social withdrawal, cognitive and physical sluggishness.

• Bipolar Disorder: Alternating periods of depression and mania (elevated mood, energy, impulsivity).

Depressive Explanatory Style

People with depression often attribute negative events to internal, stable, and global causes, which perpetuates their symptoms.

Biological and Genetic Vulnerability to Depression

Genetic factors contribute to depression risk, as shown by twin studies. The interaction between genetic predisposition and life stress (diathesis-stress model) is crucial in the development of depression.

Sociocultural and Environmental Risk Factors

• Neighborhood conditions: Substandard housing, crime, daily stress.

• Community and social networks: Poverty, economic stress, high residential turnover, fewer support systems.

• Social media: May influence mood symptoms through social comparison and belonging.

Schizophrenia

Schizophrenia is a severe disorder involving breaks from reality, disorganized thinking, and emotional disturbances. Symptoms are classified as:

• Positive symptoms: Hallucinations, delusions, thought disorder, movement disorder.

• Negative symptoms: Absence of adaptive behaviors (e.g., flat affect, social withdrawal).

Biological factors include brain structure abnormalities (e.g., enlarged ventricles, reduced frontal lobe activity) and neurotransmitter imbalances (dopamine overactivity, glutamate underactivity). Environmental factors such as stress, low socioeconomic status, minority status, prenatal environment, and cannabis use also contribute.

Personality Disorders

Personality disorders are enduring patterns of behavior that are maladaptive, distressing, and resistant to change. They are grouped into three clusters:

• Cluster A: Odd or eccentric (e.g., paranoid, schizoid).

• Cluster B: Dramatic, emotional, erratic (e.g., antisocial, borderline, narcissistic).

• Cluster C: Anxious, fearful, inhibited (e.g., avoidant).

Borderline Personality Disorder

Characterized by intense emotional swings, unstable self-image, impulsivity, and tumultuous relationships. Often rooted in early trauma or inconsistent parenting.

Antisocial Personality Disorder (APD) and Psychopathy

APD involves a lack of empathy, disregard for others' rights, and often violent or manipulative behavior. Psychopathy is a more severe form, with interpersonal/emotional deficits and social deviance. Brain differences include under-reactivity to stress, amygdala abnormalities, and frontal lobe impairments.

Uncommon Psychiatric Syndromes

• Capgras's syndrome: Belief that a loved one has been replaced by an impostor.

• Ekbom's syndrome: Delusions of infestation.

• Munchausen syndrome: Fabrication of medical symptoms for attention or care.

Psychological Disorders and the Legal System

The Insanity Defence (NCRMD)

"Not Criminally Responsible by Reason of Mental Disorder" (NCRMD) is a legal, not psychological, definition. It applies when a mental disorder prevents understanding the nature or wrongfulness of an act. The Canadian Criminal Code (S.16) outlines the criteria for NCRMD.

• Actus reus: The guilty action.

• Mens rea: The guilty mind (intent).

Possible outcomes after an NCRMD finding include absolute discharge, conditional discharge, or detention in a hospital, depending on risk and treatment needs. Decisions are made by a Review Board, not a judge.

Myths and Realities of NCRMD

• Myth: NCRMD is frequently used and successful. Reality: Used in only 1% of felony cases, fails 75% of the time.

• Myth: NCRMD is a loophole for the guilty. Reality: Most spend time in hospital or jail; few get absolute discharge.

• Myth: Mentally ill people are highly dangerous. Reality: Most NCRMD cases are non-violent; recidivism is low.

• Myth: NCRMD leads to quick release. Reality: Most are detained longer than if found guilty.

Mental Illness and the Criminal Justice System

Deinstitutionalization and lack of community services have led to increased contact between people with mental illness and the criminal justice system. Many enter with pre-existing mental health issues or develop them during incarceration. Prisons are often ill-equipped to provide adequate care, and conditions such as solitary confinement can worsen symptoms.

• ~70% of federally incarcerated individuals report mental health symptoms.

• ~40% of incoming federal inmates meet criteria for a current mental disorder.

• Suicide rates in prison far exceed national averages.

Solitary confinement can cause hallucinations, cognitive disabilities, insomnia, self-harm, paranoia, and suicidal tendencies. Neurological effects include changes in brain structure and function.

Advocacy and Support

Organizations such as the John Howard Society, Fred Victor, Elizabeth Fry Society, Addictions and Mental Health Ontario (AMHO), CMHA, and CAMH provide support and advocate for humane treatment and services for individuals with mental illness.