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Fundamentals-of-Psychological-Disorders.txt
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Fundamentals-of-Psychological-Disorders.txt
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Fundamentals of Psychological DisordersFundamentals of Psychological DisordersPDF Version of the Textbook – Fundamentals of Psychological Disorders – 3rd
edition 5TR – version 3.5
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Additional languages available: Bahasa Indonesia , Deutsch , français , hrvatski , italiano , Nederlands ,
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the FAQ for more information about official translations.Contents
Licensing Information II ..............................................................................................................................
Table of Contents IX ....................................................................................................................................
Record of Changes XI ..................................................................................................................................
DSM-5-TR Statement XII .............................................................................................................................
Tokens of Appreciation XIII .........................................................................................................................
Other Books in the Discovering Psychology Series XIV ..............................................................................
Part I. Setting the Stage .............................................................................................................................
Module 1: What is Abnormal Psychology? 16 .......................................................................................
Module 2: Models of Abnormal Psychology 50 .....................................................................................
Module 3: Clinical Assessment, Diagnosis, and Treatment 85 .............................................................
Part II. Mental Disorders – Block 1 .............................................................................................................
Module 4: Mood Disorders 102 ............................................................................................................
Module 5: Trauma- and Stressor-Related Disorders 125 .....................................................................
Module 6: Dissociative Disorders 142 ..................................................................................................
Part III. Mental Disorders – Block 2 ...........................................................................................................
Module 7: Anxiety Disorders 155 .........................................................................................................
Module 8: Somatic Symptom and Related Disorders 173 ....................................................................
Module 9: Obsessive-Compulsive and Related Disorders 188 ..............................................................
Part IV. Mental Disorders – Block 3 ...........................................................................................................
Module 10: Feeding and Eating Disorders 203 ....................................................................................
Module 11: Substance-Related and Addictive Disorders 218 ...............................................................
Part V. Mental Disorders – Block 4 .............................................................................................................
Module 12: Schizophrenia Spectrum and Other Psychotic Disorders 238 ...........................................
Module 13: Personality Disorders 254 .................................................................................................
Part VI. Mental Disorders – Block 5 ...........................................................................................................
Module 14: Neurocognitive Disorders 275 ...........................................................................................
Module 15: Contemporary Issues in Psychopathology 288 ..................................................................
Module 16: Disorders of Childhood Overview 297 ...............................................................................
Glossary 327 ................................................................................................................................................
References 328 ............................................................................................................................................
Index 329 ..................................................................................................................................................... II1
Licensing Information
Alexis Bridley and Lee W. Daffin Jr.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0
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Table of Contents
Preface
Record of Changes
Part I. Setting the Stage
• Module 1: What is Abnormal Psychology? 1-1
• Module 2: Models of Abnormal Psychology 2-1
• Module 3: Clinical Assessment, Diagnosis, and Treatment 3-1
Part II. Mental Disorders – Block 1
• Module 4: Mood Disorders 4-1
• Module 5: Trauma- and Stressor-Related Disorders 5-1
• Module 6: Dissociative Disorders 6-1
Part III. Mental Disorders – Block 2
• Module 7: Anxiety Disorders 7-1
• Module 8: Somatic Symptom and Related Disorders 8-1
• Module 9: Obsessive-Compulsive and Related Disorders 9-1
Part IV. Mental Disorders – Block 3
• Module 10: Feeding and Eating Disorders 10-1
• Module 11: Substance-Related and Addictive Disorders 11-1
Part V. Mental Disorders – Block 4
• Module 12: Schizophrenia Spectrum and Other Psychotic Disorders 12-1
• Module 13: Personality Disorders 13-1XPart VI. Mental Disorders – Block 5
• Module 14: Neurocognitive Disorders 14-1
• Module 15: Contemporary Issues in Psychopathology 15-1
• Module 16: Disorders of Childhood Overview 16-1
Glossary
References
Index
Instructors – See the Instructor Resources Instructions – Read First page to request access to Instructor
Resources.XI3
Record of Changes
Edition As of Date Changes Made
1.0 Fall 2017 Initial writing; feedback pending
1.01 Spring 2018 Addition of Modules 2, 3, and 15
1.02Summer
2018Addition of Index, Glossary, and Preface; made minor edits based on student feedback.
1.03Summer
2019Proofreading edits
2.00 August 2020Proofreading edits and overall improvements such as end of section summaries and review questions. Added a Tokens of
Appreciation page. Added lecture slides courtesy of Arizona State University.
2.05November
2021Section 1.1.1. changed the following: “Psychology worked with the disease model for over 60 years, from about the late
1800s into the middle part of the 20th century.” It previously indicated 19th century when it should have said 20th which
was the mid-1900s. Thank you to Dr. Irving Herman of Columbia University for pointing this out.
3.00 August 2022NAME CHANGE – The name of the book has changed from Abnormal Behavior to Fundamentals of Psychological
Disorders. We have continued with the numerical progression of edition numbers, making this three, despite the shift in
name. We do not want instructors using the book to believe the book is different. Additional round of text revisions but
main changes were to update the book to the newly released DSM 5-TR in March 2022. Some references have been
updated as well.
3.5 July 2023Addition of Module 16: Disorders of Childhood Overview; updating of the references, index, glossary, and front matter,
accordingly. Creation of new PDF of the entire book.
XII4
DSM-5-TR Statement
DSM-5-TR Conversion COMPLETE as of
8-1-2022
We are pleased to announce that the final module was updated to DSM-5-TR. Be advised that the
sections in each module on Clinical Presentation, Epidemiology, and Comorbidity were updated for
DSM-5-TR and new statistics provided when applicable.
The sections on Etiology and Treatment were not updated unless there was an issue identified to us by a
user of this book. They did receive another proofread. These sections will be updated in version 3.5 and
by summer 2023.
Instructor resources will be updated during the fall 2022 as time permits. The priority will be on the
lectures and test banks, followed by OpenClass and other resources.
Note that with this edition the name of the book changed to Fundamentals of Psychological Disorders
and from Abnormal Behavior. We believe this better represents the scope of the textbook.
Thank you for your patience and we hope you enjoy the book. A PDF of the book is provided at the top
of the title page once you select Read.
Lee Daffin for Alexis BridleyXIII5
Tokens of Appreciation
August 2022
Alexis and I want to offer a special thank you to Ms. Celeste Ernst, undergraduate within the online
Bachelor of Science degree in Psychology program, for her edits of the 1st edition during the spring
2020. Her changes, and our own, were integrated into the 2nd edition of the book and are a dramatic
improvement over the 1st edition. Thank you, Celeste. Many of those changes will be present in the 3rd
edition and improved upon as we transition to DSM 5-TR.
We would also like to extend a special thank you to Madeleine Stewart and Matt Meier, PsyD., of the
Department of Psychology at Arizona State University for the development of the lecture slides for this
book. They did this work unsolicited and produced top quality presentations which we will include in a
password protected page, along with additional ancillaries such as an Instructor’s Manual and test
banks, in the very near future (i.e. hopefully by mid fall semester at the latest but the slides in August)
and for Instructors (Not students. Sorry). Thank you again for your excellent work, Madeleine and Matt.
It is more appreciated than you could ever imagine.
And now to our reader. We hope you enjoy the book and please, if you see any issues whether
typographical, factual, or just want to suggest some type of addition to the material or another way to
describe a concept, general formatting suggestion, etc. please let us know. The beauty of Open
Education Resources (OER) is that we can literally make a minor change immediately and without the
need for expensive printings of a new edition. And it’s available for everyone right away. If you have
suggestions, please email them to either Alexis or myself (Lee Daffin) using the emails on the title page.
Enjoy the 3rd edition of Fundamentals of Psychological Disorders (formerly Abnormal Psychology).
Lee Daffin
On behalf of, Alexis BridleyXIV6
Other Books in the Discovering Psychology
Series
Interested in learning more about the field of psychology? Please visit any of the books in the
Discovering Psychology Series of texts.
The Psychology of Gender, 2nd edition
Principles of Social Psychology, 2nd edition
Principles of Analysis and Behavior, 4th edition
Motivation, 2nd edition
Behavioral Disorders of Childhood, 2nd edition
Drugs and Behavior, 1st edition
Principles of Learning and Behavior, 2nd editionI
Part I. Setting the Stage
3rd edition as of July 2023
Part I. Setting the Stage
Topics Covered:
What is Abnormal Psychology?1.
Models of Abnormal Psychology2.
Clinical Assessment, Diagnosis, and Treatment3.16Module 1: What is Abnormal Psychology?
3rd edition as of July 2023
Module Overview
Cassie is an 18-year-old female from suburban Seattle, WA. She was a successful student in high school,
graduating valedictorian and obtaining a National Merit Scholarship for her performance on the PSAT
during her junior year. She was accepted to a university on the opposite side of the state, where she
received additional scholarships giving her a free ride for her entire undergraduate education. Excited
to start this new chapter in her life, Cassie’s parents begin the 5-hour commute to Pullman, where they
will leave their only daughter for the first time in her life.
The semester begins as it always does in mid to late August. Cassie meets the challenge with
enthusiasm and does well in her classes for the first few weeks of the semester, as expected. Sometime
around Week 6, her friends notice she is despondent, detached, and falling behind in her work. After
being asked about her condition, she replies that she is “just a bit homesick,” and her friends accept
this answer as it is a typical response to leaving home and starting college for many students. A month
later, her condition has not improved but worsened. She now regularly shirks her responsibilities
around her apartment, in her classes, and on her job. Cassie does not hang out with friends like she did
when she first arrived for college and stays in bed most of the day. Concerned, Cassie’s friends contact
Health and Wellness for help.
Cassie’s story, though hypothetical, is true of many Freshmen leaving home for the first time to earn a
higher education, whether in rural Washington state or urban areas such as Chicago and Dallas. Most
students recover from this depression and go on to be functional members of their collegiate
environment and accomplished scholars. Some students learn to cope on their own while others seek
assistance from their university’s health and wellness center or from friends who have already been
through the same ordeal. These are normal reactions. However, in cases like Cassie’s, the path to
recovery is not as clear. Instead of learning how to cope, their depression increases until it reaches
clinical levels and becomes an impediment to success in multiple domains of life such as home, work,
school, and social circles.
In Module 1, we will explore what it means to display abnormal behavior, what mental disorders are,
and the way society views mental illness today and how it has been regarded throughout history. Then
we will review research methods used by psychologists in general and how they are adapted to study
abnormal behavior/mental disorders. We will conclude with an overview of what mental health
professionals do.
Module Outline
1.1. Understanding Abnormal Behavior
1.2. Classifying Mental Disorders
1.3. The Stigma of Mental IllnessFundamentals of Psychological Disorders
171.4. The History of Mental Illness
1.5. Research Methods in Psychopathology
1.6. Mental Health Professionals, Societies, and Journals
Module Learning Outcomes
Explain what it means to display abnormal behavior.
Clarify how mental health professionals classify mental disorders.
Describe the effect of stigma on those who have a mental illness.
Outline the history of mental illness.
Describe the research methods used to study abnormal behavior and mental illness.
Identify types of mental health professionals, societies they may join, and journals they can
publish their work in.
1.1. Understanding Abnormal Behavior
Section Learning Objectives
Describe the disease model and its impact on the field of psychology throughout history.
Describe positive psychology.
Define abnormal behavior.
Explain the concept of dysfunction as it relates to mental illness.
Explain the concept of distress as it relates to mental illness.
Explain the concept of deviance as it relates to mental illness.
Explain the concept of dangerousness as it relates to mental illness.
Define culture and social norms.
Clarify the cost of mental illness on society.
Define abnormal psychology, psychopathology, and mental disorders.
1.1.1. Understanding Abnormal Behavior
To understand what abnormal behavior is, we first have to understand what normal behavior is. Normal
really is in the eye of the beholder, and most psychologists have found it easier to explain what is wrong
with people then what is right. How so?
Psychology worked with the disease model for over 60 years, from about the late 1800s into the middle
part of the 20th century. The focus was simple – curing mental disorders – and included such pioneers
as Freud, Adler, Klein, Jung, and Erickson. These names are synonymous with the psychoanalytical
school of thought. In the 1930s, behaviorism, under B.F. Skinner, presented a new view of humanFundamentals of Psychological Disorders
18behavior. Simply, human behavior could be modified if the correct combination of reinforcements and
punishments were used. This viewpoint espoused the dominant worldview of the time – mechanism –
which presented the world as a great machine explained through the principles of physics and
chemistry. In it, human beings serve as smaller machines in the larger machine of the universe.
Moving into the mid to late 1900s, we developed a more scientific investigation of mental illness, which
allowed us to examine the roles of both nature and nurture and to develop drug and psychological
treatments to “make miserable people less miserable.” Though this was an improvement, there were
three consequences as pointed out by Martin Seligman in his 2008 TED Talk entitled, “The new era of
positive psychology.” These are:
“The first was moral; that psychologists and psychiatrists became victimologists, pathologizers;
that our view of human nature was that if you were in trouble, bricks fell on you. And we forgot
that people made choices and decisions. We forgot responsibility. That was the first cost.”
“The second cost was that we forgot about you people. We forgot about improving normal lives.
We forgot about a mission to make relatively untroubled people happier, more fulfilled, more
productive. And “genius,” “high-talent,” became a dirty word. No one works on that.”
“And the third problem about the disease model is, in our rush to do something about people in
trouble, in our rush to do something about repairing damage, it never occurred to us to develop
interventions to make people happier — positive interventions.”
Starting in the 1960s, figures such as Abraham Maslow and Carl Rogers sought to overcome the
limitations of psychoanalysis and behaviorism by establishing a “third force” psychology, also known as
humanistic psychology. As Maslow said,
“The science of psychology has been far more successful on the negative than on the positive side; it
has revealed to us much about man’s shortcomings, his illnesses, his sins, but little about his
potentialities, his virtues, his achievable aspirations, or his full psychological height. It is as if
psychology had voluntarily restricted itself to only half its rightful jurisdiction, and that the darker,
meaner half.” (Maslow, 1954, p. 354).
Humanistic psychology instead addressed the full range of human functioning and focused on personal
fulfillment, valuing feelings over intellect, hedonism, a belief in human perfectibility, emphasis on the
present, self-disclosure, self-actualization, positive regard, client centered therapy, and the hierarchy of
needs. Again, these topics were in stark contrast to much of the work being done in the field of
psychology up to and at this time.
In 1996, Martin Seligman became the president of the American Psychological Association (APA) and
called for a positive psychology or one that had a more positive conception of human potential and
nature. Building on Maslow and Roger’s work, he ushered in the scientific study of such topics as
happiness, love, hope, optimism, life satisfaction, goal setting, leisure, and subjective well-being.
Though positive and humanistic psychology have similarities, their methodology was much different.
While humanistic psychology generally relied on qualitative methods, positive psychology utilizes a
quantitative approach and aims to help people make the most out of life’s setbacks, relate well to
others, find fulfillment in creativity, and find lasting meaning and satisfaction
(https://www.positivepsychologyinstitute.com.au/what-is-positive-psychology ).
So, to understand what normal behavior is, do we look to positive psychology for an indication, or do we
first define abnormal behavior and then reverse engineer a definition of what normal is? Our precedingFundamentals of Psychological Disorders
19discussion gave suggestions about what normal behavior is, but could the darker elements of our
personality also make up what is normal to some extent? Possibly. The one truth is that no matter what
behavior we display, if taken to the extreme, it can become disordered – whether trying to control
others through social influence or helping people in an altruistic fashion. As such, we can consider
abnormal behavior to be a combination of personal distress, psychological dysfunction, deviance from
social norms, dangerousness to self and others, and costliness to society.
1.1.2. How Do We Determine What Abnormal Behavior Is?
In the previous section we showed that what we might consider normal behavior is difficult to define.
Equally challenging is understanding what abnormal behavior is, which may be surprising to you. A
publication which you will become intimately familiar with throughout this book, the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition, Text
Revision (DSM-5-TR; 2022), states that, “Although no definition can capture all aspects of the range of
disorders contained in DSM-5″ (pg. 13) certain aspects are required. These include:
Dysfunction – Includes “clinically significant disturbance in an individual’s cognition, emotion
regulation, or behavior that reflects a dysfunction in the psychological, biological, or
developmental processes underlying mental functioning” (pg. 14). Abnormal behavior, therefore,
has the capacity to make well-being difficult to obtain and can be assessed by looking at an
individual’s current performance and comparing it to what is expected in general or how the
person has performed in the past. As such, a good employee who suddenly demonstrates poor
performance may be experiencing an environmental demand leading to stress and ineffective
coping mechanisms. Once the demand resolves itself, the person’s performance should return to
normal according to this principle.
Distress – When the person experiences a disabling condition “in social, occupational, or other
important activities” (pg. 14). Distress can take the form of psychological or physical pain, or both
concurrently. Alone though, distress is not sufficient enough to describe behavior as abnormal.
Why is that? The loss of a loved one would cause even the most “normally” functioning individual
pain. An athlete who experiences a career-ending injury would display distress as well. Suffering
is part of life and cannot be avoided. And some people who exhibit abnormal behavior are
generally positive while doing so.
Deviance – Closer examination of the word abnormal indicates a move away from what is normal,
or the mean (i.e., what would be considered average and in this case in relation to behavior), and
so is behavior that infrequently occurs (sort of an outlier in our data). Our culture , or the totality
of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other
products that are particular to a group, determines what is normal. Thus, a person is said to be
deviant when he or she fails to follow the stated and unstated rules of society, called social
norms . Social norms change over time due to shifts in accepted values and expectations. For
instance, homosexuality was taboo in the U.S. just a few decades ago, but today, it is generally
accepted. Likewise, PDAs, or public displays of affection, do not cause a second look by most
people unlike the past when these outward expressions of love were restricted to the privacy of
one’s own house or bedroom. In the U.S., crying is generally seen as a weakness for males.
However, if the behavior occurs in the context of a tragedy such as the Vegas mass shooting on
October 1, 2017, in which 58 people were killed and about 500 were wounded while attending the
Route 91 Harvest Festival, then it is appropriate and understandable. Finally, consider thatFundamentals of Psychological Disorders
20statistically deviant behavior is not necessarily negative. Genius is an example of behavior that is
not the norm.
Though not part of the DSM conceptualization of what abnormal behavior is, many clinicians add
dangerousness to this list when behavior represents a threat to the safety of the person or others. It is
important to note that having a mental disorder does not imply a person is automatically dangerous.
The depressed or anxious individual is often no more a threat than someone who is not depressed, and
as Hiday and Burns (2010) showed, dangerousness is more the exception than the rule. Still, mental
health professionals have a duty to report to law enforcement when a mentally disordered individual
expresses intent to harm another person or themselves. It is important to point out that people seen as
dangerous are also not automatically mentally ill.
1.1.3. The Costs of Mental Illness
This leads us to wonder what the cost of mental illness is to society. The National Alliance on Mental
Illness (NAMI) states that mental illness affects a person’s life which then ripples out to the family,
community, and world. For instance, people with serious mental illness are at increased risk for
diabetes, cancer, and cardiometabolic disease while 18% of those with a mental illness also have a
substance use disorder. Within the family, an estimated 8.4 million Americans provide care to an adult
with an emotional or mental illness with caregivers spending about 32 hours a week providing unpaid
care. At the community level 21% of the homeless also have a serious mental illness while 70% of youth
in the juvenile justice system have at least one mental health condition. And finally, depression is a
leading cause of disability worldwide and depression and anxiety disorders cost the global economy $1
trillion each year in lost productivity (Source: NAMI, The Ripple Effect of Mental Illness infographic;
https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers ).
In terms of worldwide impact, data from 2010 estimates $2.5 trillion in global costs, with $1.7 trillion
being indirect costs (i.e., invisible costs “associated with income losses due to mortality, disability, and
care seeking, including lost production due to work absence or early retirement”) and the remainder
being direct (i.e., visible costs to include “medication, physician visits, psychotherapy sessions,
hospitalization,” etc.). It is now projected that mental illness costs will be around $16 trillion by 2030.
The authors add, “It should be noted that these calculations did not include costs associated with
mental disorders from outside the healthcare system, such as legal costs caused by illicit drug abuse”
(Trautmann, Rehm, & Wittchen, 2016). The costs for mental illness have also been found to be greater
than the combined costs of somatic diseases such as cancer, diabetes, and respiratory disorders
(Whiteford et al., 2013).
Christensen et al. (2020) did a review of 143 cost-of-illness studies that covered 48 countries and
several types of mental illness. Their results showed that mental disorders are a substantial economic
burden for societies and that certain groups of mental disorders are more costly than others. At the
higher cost end were developmental disorders to include autism spectrum disorders followed by
schizophrenia and intellectual disabilities. They write, “However, it is important to note that while
disorders such as mood, neurotic and substance use disorders were less costly according to societal
cost per patient, these disorders are much more prevalent and thus would contribute substantially to
the total national cost in a country.” And much like Trautmann, Rehm, & Wittchen (2016) other studies
show that indirect costs are higher than direct costs (Jin & Mosweu, 2017; Chong et al., 2016).Fundamentals of Psychological Disorders
21
1.1.4. Defining Key Terms
Our discussion so far has concerned what normal and abnormal behavior is. We saw that the study of
normal behavior falls under the providence of positive psychology. Similarly, the scientific study of
abnormal behavior, with the intent to be able to predict reliably, explain, diagnose, identify the causes
of, and treat maladaptive behavior, is what we refer to as abnormal psychology . Abnormal behavior
can become pathological and has led to the scientific study of psychological disorders, or
psychopathology . From our previous discussion we can fashion the following definition of a
psychological or mental disorder: mental disorders are characterized by psychological dysfunction,
which causes physical and/or psychological distress or impaired functioning, and is not an expected
behavior according to societal or cultural standards.
Key Takeaways
You should have learned the following in this section:
Abnormal behavior is a combination of personal distress, psychological dysfunction, deviance
from social norms, dangerousness to self and others, and costliness to society.
Abnormal psychology is the scientific study of abnormal behavior, with the intent to be able to
predict reliably, explain, diagnose, identify the causes of, and treat maladaptive behavior.
The study of psychological disorders is called psychopathology.
Mental disorders are characterized by psychological dysfunction, which causes physical and/or
psychological distress or impaired functioning, and is not an expected behavior according to
societal or cultural standards
Section 1.1 Review Questions
What is the disease model and what problems existed with it? What was to overcome its1.
limitations?
Can we adequately define normal behavior? What about abnormal behavior?2.
What aspects are part of the American Psychiatric Association’s definition of abnormal behavior?3.
How costly is mental illness?4.
What is abnormal psychology?5.
What is psychopathology?6.
How do we define mental disorders?7.
Fundamentals of Psychological Disorders
221.2. Classifying Mental Disorders
Section Learning Objectives
Define and exemplify classification.
Define nomenclature.
Define epidemiology.
Define the presenting problem and clinical description.
Differentiate prevalence, incidence, and any subtypes.
Define comorbidity.
Define etiology.
Define course.
Define prognosis.
Define treatment.
1.2.1. Classification
Classification is not a foreign concept and as a student you have likely taken at least one biology class
that discussed the taxonomic classification system of Kingdom, Phylum, Class, Order, Family, Genus,
and Species revolutionized by Swedish botanist, Carl Linnaeus. You probably even learned a witty
mnemonic such as ‘King Phillip, Come Out For Goodness Sake’ to keep the order straight. The Library
of Congress uses classification to organize and arrange their book collections and includes such
categories as B – Philosophy, Psychology, and Religion; H – Social Sciences; N – Fine Arts; Q – Science;
R – Medicine; and T – Technology.
Simply, classification is how we organize or categorize things. The second author’s wife has been
known to color-code her Blu Ray collection by genre, movie title, and release date. It is useful for us to
do the same with abnormal behavior, and classification provides us with a nomenclature , or naming
system, to structure our understanding of mental disorders in a meaningful way. Of course, we want to
learn as much as we can about a given disorder so we can understand its cause, predict its future
occurrence, and develop ways to treat it.
1.2.2. Determining Occurrence of a Disorder
Epidemiology is the scientific study of the frequency and causes of diseases and other health-related
states in specific populations such as a school, neighborhood, a city, country, and the world.
Psychiatric or mental health epidemiology refers to the occurrence of mental disorders in a
population. In mental health facilities, we say that a patient presents with a specific problem, or the
presenting problem , and we give a clinical description of it, which includes information about the
thoughts, feelings, and behaviors that constitute that mental disorder. We also seek to gain information
about the occurrence of the disorder, its cause, course, and treatment possibilities.
Occurrence can be investigated in several ways. First, prevalence is the percentage of people in aFundamentals of Psychological Disorders
23population that has a mental disorder or can be viewed as the number of cases divided by the total
number of people in the sample. For instance, if 20 people out of 100 have bipolar disorder, then the
prevalence rate is 20%. Prevalence can be measured in several ways:
Point prevalence indicates the proportion of a population that has the characteristic at a specific
point in time. In other words, it is the number of active cases.
Period prevalence indicates the proportion of a population that has the characteristic at any
point during a given period of time, typically the past year.
Lifetime prevalence indicates the proportion of a population that has had the characteristic at
any time during their lives.
According to a 2020 infographic by the National Alliance on Mental Illness (NAMI), for U.S. adults, 1 in
5 experienced a mental illness, 1 in 20 had a serious mental illness, 1 in 15 experienced both a
substance use disorder and mental disorder, and over 12 million had serious thoughts of suicide (2020
Mental Health By the Numbers: US Adults infographic). In terms of adolescents aged 12-17, in 2020 1
in 6 experienced a major depressive episode, 3 million had serious thoughts of suicide, and there was a
31% increase in mental health-related emergency department visits. Among U.S. young adults aged
18-25, 1 in 3 experienced a mental illness, 1 in 10 had a serious mental illness, and 3.8 had serious
thoughts of suicide (2020 Mental Health By the Numbers: Youth and Young Adults infographic). These
numbers would represent period prevalence rates during the pandemic, and for the year 2020. In the,
You are Not Alone infographic, NAMI reported the following 12-month prevalence rates for U.S. Adults:
19% having an anxiety disorder, 8% having depression, 4% having PTSD, 3% having bipolar disorder,
and 1% having schizophrenia.
Source: https://www.nami.org/mhstats
Incidence indicates the number of new cases in a population over a specific period. This measure is
usually lower since it does not include existing cases as prevalence does. If you wish to know the
number of new cases of social phobia during the past year (going from say Aug 21, 2015 to Aug 20,
2016), you would only count cases that began during this time and ignore cases before the start date,
even if people are currently afflicted with the mental disorder. Incidence is often studied by medical and
public health officials so that causes can be identified, and future cases prevented.
Finally, comorbidity describes when two or more mental disorders are occurring at the same time and
in the same person. The National Comorbidity Survey Replication (NCS-R) study conducted by the
National Institute of Mental Health (NIMH) and published in the June 6, 2005 issue of the Archives of
General Psychiatry, sought to discover trends in prevalence, impairment, and service use during the
1990s. The first study, conducted from 1980 to 1985, surveyed 20,000 people from five different
geographical regions in the U.S. A second study followed from 1990-1992 and was called the National
Comorbidity Survey (NCS). The third study, the NCS-R, used a new nationally representative sample of
the U.S. population, and found that 45% of those with one mental disorder met the diagnostic criteria
for two or more disorders. The authors also found that the severity of mental illness, in terms of
disability, is strongly related to comorbidity, and that substance use disorders often result from
disorders such as anxiety and bipolar disorders. The implications of this are significant as services to
treat substance abuse and mental disorders are often separate, despite the disorders appearing
together.Fundamentals of Psychological Disorders
24
1.2.3. Other Key Factors Related to Mental Disorders
The etiology is the cause of the disorder. There may be social, biological, or psychological explanations
for the disorder which need to be understood to identify the appropriate treatment. Likewise, the
effectiveness of a treatment may give some hint at the cause of the mental disorder. More on this in
Module 2.
The course of the disorder is its particular pattern. A disorder may be acute , meaning that it lasts a
short time, or chronic, meaning it persists for a long time. It can also be classified as time-limited ,
meaning that recovery will occur after some time regardless of whether any treatment occurs.
Prognosis is the anticipated course the mental disorder will take. A key factor in determining the
course is age, with some disorders presenting differently in childhood than adulthood.
Finally, we will discuss several treatment strategies in this book in relation to specific disorders, and in
a general fashion in Module 3. Treatment is any procedure intended to modify abnormal behavior into
normal behavior. The person suffering from the mental disorder seeks the assistance of a trained
professional to provide some degree of relief over a series of therapy sessions. The trained mental
health professional may prescribe medication or utilize psychotherapy to bring about this change.
Treatment may be sought from the primary care provider, in an outpatient facility, or through inpatient
care or hospitalization at a mental hospital or psychiatric unit of a general hospital. According to NAMI,
the average delay between symptom onset and treatment is 11 years with 45% of adults with mental
illness, 66% of adults with serious mental illness, and 51% of youth with a mental health condition
seeking treatment in a given year. They also report that 50% of white, 49% of lesbian/gay and bisexual,
43% of mixed/multiracial, 34% of Hispanic or Latinx, 33% of black, and 23% of Asian adults with a
mental health diagnosis received treatment or counseling in the past year (Source: Mental Health Care
Matters infographic, https://www.nami.org/mhstats ).
Key Takeaways
You should have learned the following in this section:
Classification, or how we organize or categorize things, provides us with a nomenclature, or
naming system, to structure our understanding of mental disorders in a meaningful way.
Epidemiology is the scientific study of the frequency and causes of diseases and other health-
related states in specific populations.
Prevalence is the percentage of people in a population that has a mental disorder or can be
viewed as the number of cases divided by the total number of people in the sample.
Incidence indicates the number of new cases in a population over a specific period.
Comorbidity describes when two or more mental disorders are occurring at the same time and in
the same person.
The etiology is the cause of a disorder while the course is its particular pattern and can be acute,
chronic, or time-limited.
Prognosis is the anticipated course the mental disorder will take.Fundamentals of Psychological Disorders
25
Section 1.2 Review Questions
What is the importance of classification for the study of mental disorders?1.
What information does a clinical description include?2.
In what ways is occurrence investigated?3.
What is the etiology of a mental illness?4.
What is the relationship of course and prognosis to one another?5.
What is treatment and who seeks it?6.
1.3. The Stigma of Mental Illness