The Concept of Disorder - Personality psychology.
The Concept of Disorder.
Today, a psychological disorder is a pattern of behavior or experience that is distressing and painful to the person that leads to disability or impairment in important life domains (e.g. Problems with work, marriage, or relationship difficulties), and that is associated with increased risk for further suffering, loss of function, death, or confinement (America psychiatric association, 1994). The idea that something can go wrong with a person’s personality has a long history. Some of the earliest writings in medical psychiatry included classifications and descriptions of personality and mental disorders (e.g. kraepelin, 1913; Kretschmer, 1925). A very early concept derived by French psychiatrist Philippe Pinel was manie sans delire, or madness without loss of reason. This was applied to individuals who demonstrated disordered behavior and emotions but who did not lose contact with reality (Morey, 1997). A related concept, popular in the early 1900s, was called moral insanity, to emphasize that the person did not suffer any impairment of intellect but, rather, was impaired in terms of feelings, temperament, or habits. An influential psychiatrist named Kurt Schneider (1958) proposed the term psychopathic personality to refer to behavior patterns that caused the person and the community to suffer. Schneider also emphasized statistical rarity along with behaviors that have an adverse impact on the person and the community in which that person lives. This definition highlights the notion that all forms of personality disorder involve impaired social relationships; other people suffer as much as or more than the person with the disorder.
A disorder is a conceptual entity that, although abstract, is nevertheless useful. It helps guide thinking about the distinction between what is normal and what is abnormal, or pathological. The field of abnormal psychology is the study of various mental disorders. In this chapter, we will focus on disorders of personality and the ways in which they affect functioning.
What Is Abnormal?
There are many ways to define abnormal. One simple definition is that whatever is different from normal is abnormal. That is a statistical definition, in the sense that researchers can statistically determine how often something occurs and, if it is rare, call it abnormal. In this sense, colorblindness or polydactyl (having more than 10 fingers) is considered abnormal. Another definition of abnormal is a social definition based on what society tolerates (Shoben, 1957). If we define the term in this sense, behaviors that society deems unacceptable are labeled as abnormal. In this sense, incest and child abuse are both considered abnormal. Both the statistical and the social definitions of abnormality suffer from changing times and changing social or cultural norms (Millon, 2000a, 2000b). Behaviors deemed offensive or socially inappropriate 20 years ago might be acceptable today. For example, 20 or 30 years ago, homosexuality was considered to be both rare and unacceptable, a form of abnormal behavior or even a mental illness. Today, homosexuality is not considered abnormal in itself (American psychiatric association, 1994) and is protected under civil rights law in most states. Thus, the statistical and social definitions of abnormality are always somewhat tentative because society changes.
Psychologists have consequently looked to other ways of identifying what is abnormal in behavior and experience. They have looked within persons, inquiring about subjective feelings, such as anxiety, depression, dissatisfaction, and feelings of loneliness. They have looked at how people think and experience themselves and their worlds. Psychologists have found that some people have disorganized thoughts, disruptive perceptions, or unusual beliefs and attitudes that do not match their circumstances. They have identified ways in which people fail to get along with one another and ways people have trouble living in the community. They have analyzed patterns of behavior that represent ineffective efforts at coping or that put people at higher risk for other problems, behaviors that harm more than help. From a psychological perspective, any of these may be considered abnormal.
Combining all these approaches to abnormality (statistical, social, and psychological), psychologists and psychiatrists have developed the field of psychopathology, or the study of mental disorders. The diagnosis of mental disorders is both a scientific discipline and an important part of the clinical work of many psychiatrists and psychologists. Knowing how to define and how to identify a disorder is the first step in devising treatment or designing research on that disorder.
A system for diagnosing and describing mental disorders that are widely accepted is included in the diagnostic and statistical manual of mental disorders, now in its fourth edition, commonly called the DSM-IV, published by the American psychiatric association (1994) this is a widely used manual for determining the nature and extent of psychological disorders, based on various symptoms and behaviors. This manual lists more than 200 mental disorders. Working through this manual often forms the basis of advanced or graduate-level courses in abnormal psychology.
