What is a mental disorder? Evaluating the lay concept of Mental Ill Health in the United States

Abstract

Purpose How “mental disorder” should be defined has been the focus of extensive theoretical and philosophical debate, but how the concept is understood by laypeople has received much less attention. The study aimed to examine the content (distinctive features and inclusiveness) of these concepts, their degree of correspondence to the DSM-5 definition, and whether alternative concept labels (“mental disorder”, “mental illness”, “mental health problem”, “psychological issue”) have similar or different meanings. Methods We investigated concepts of mental disorder in a nationally representative sample of 600 U.S. residents. Subsets of participants made judgments about vignettes describing people with 37 DSM-5 disorders and 24 non-DSM phenomena including neurological conditions, character flaws, bad habits, and culture-specific syndromes. Results Findings indicated that concepts of mental disorder were primarily based on judgments that a condition is associated with emotional distress and impairment, and that it is rare and aberrant. Disorder judgments were only weakly associated with the DSM-5: many DSM-5 conditions were not judged to be disorders and many non-DSM conditions were so judged. “Mental disorder”, “mental illness”, and “mental health problem” were effectively identical in meaning, but “psychological issue” was somewhat more inclusive, capturing a broader range of conditions. Conclusion These findings clarify important issues surrounding how laypeople conceptualize mental disorder. Our findings point to some significant points of disagreement between professional and public understandings of disorder, while also establishing that laypeople’s concepts of mental disorder are systematic and structured.

Individual differences in the expansiveness of mental disorder concepts: development and validation of concept breadth scales

“…Ten vignettes, each describing a DSM-5 disorder, were selected from a set of 61 vignettes developed by Tse and Haslam [ 25 ]. The 10 diverse disorders – schizophrenia, bipolar I disorder (manic episode), major depressive disorder, generalised anxiety disorder, obsessive compulsive disorder, dissociative identity disorder, binge eating disorder, conduct disorder, gambling disorder, and avoidant personality disorder – were chosen for their relatively high familiarity to the public.…”

“…The 10 diverse disorders – schizophrenia, bipolar I disorder (manic episode), major depressive disorder, generalised anxiety disorder, obsessive compulsive disorder, dissociative identity disorder, binge eating disorder, conduct disorder, gambling disorder, and avoidant personality disorder – were chosen for their relatively high familiarity to the public. Based on each original vignette’s mean rating on the item “This person has a mental disorder” from Tse and Haslam’s [ 25 ] study, four new versions of each vignette were written to describe varying levels of severity of the same disorder both below and above the original version. The intended outcome was a set of five vignettes for each disorder whose severity levels increased in small steps from a clearly subthreshold case to a case that clearly exceeded the diagnostic threshold.…”

“…As with the candidate vertical scale items, the candidate items for the horizontal breadth scale were sourced from Tse and Haslam’s [ 25 ] vignettes. Ten DSM-5 disorders (persistent depressive disorder, social anxiety disorder, posttraumatic stress disorder, somatic symptom disorder, insomnia disorder, gender dysphoria, delirium, mild neurocognitive disorder, narcissistic personality disorder, and sexual masochism disorder) and 10 non-disorders (recurrent cheating, jealousy, selfishness, poor hygiene, social media disorder, chronic fatigue syndrome, prosopagnosia, internet gaming disorder, Dhat, and imposter syndrome) were selected.…”

“…Several studies (e.g., [ 23 , 24 ]) have explored this question and examined cultural differences in the breadth and key defining features of disorder concepts. For instance, Tse and Haslam [ 25 ] found that American participants tended to hold a concept of disorder that was similar in breadth to the DSM-5 but not closely aligned with it, and that their disorder judgments were primarily based on the extent to which a person’s problems involved severe harm (distress and impairment) and were rare.…”

Adoptive parents’ satisfaction with child and adolescent mental services and their mental health concerns over time: A question of fit?

“…Comparisons of lay versus professional understanding of mental health disorders in general populations reveal some superficial agreement but also important differences that can drive patient dissatisfaction (e.g., Butlin et al, 2019; Tse & Haslam, 2023). Thus, while formal psychiatric diagnoses typically shape how statutory mental health services are organised, when inquiring of parental concerns, it may be helpful to use descriptions of problems and concerns rather than suggestions of frank psychiatric disorders.…”