- Explain how relational, emotional, situational, and environmental problems are connected with mental health
The DSM-5 also includes content about issues that are not mental disorders, but that may be a focus of clinical attention. These conditions are connected to mental disorders and may be the reason that a person first seeks help from a clinician. These conditions include the following:
- relational problems
- abuse and neglect
- child physical abuse, sexual abuse, neglect, and psychological abuse
- adult or maltreatment and neglect problems (physical abuse, sexual abuse, neglect, and psychological abuse)
- emotional and occupational problems
- housing and economic problems
- other problems related to the social environment
- problems related to crime or interaction with the legal system
- other health service encounters for counseling and medical advice
- problems related to other psychosocial, personal, and environmental circumstances
- other circumstances of personal history
Neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. Neglect can be a result of carelessness, indifference, or unwillingness and abuse. Studies of neglected children show heightened levels of depression and hopelessness and higher incidents of suicide attempts. Also, too little parental availability can result in difficulties in problem-solving, coping with stressful situations, and social relationships.
Neglect may include the failure to provide sufficient supervision, nourishment, or medical care, or the failure to fulfill other needs for which the victim cannot provide themselves. Neglect can carry on in a child’s life falling into many long-term side effects such as: physical injuries, developmental trauma disorder, low self-esteem, attention disorders, violent behavior, and can even cause death.
There are many different types of neglect but they all have consequences, whether it be physical or mental. Neglect can affect the body physically by affecting a child’s development and health, sometimes leading to chronic medical problems. Children experiencing neglect often suffer from malnutrition, which causes abnormal patterns for development. Not being given the proper nutrients at certain growth periods can result in stunted growth, and inadequate bone and muscle growth. Brain functioning and information processing may also be affected by neglect and may lead to difficulty in understanding directions, poor understanding of social relationships, or the inability to complete academic tasks without assistance. Neglected children or adults can have physical injuries like fractures or severe burns that go untreated, or infections, lice and other signs of lack of care. There are many physical effects neglect can have on a person.
Not only is neglect associated with physical problems, it also has an effect on a person mentally, ranging from poor peer relationships to violent behavior. Not only is behavior affected, but the way a person looks at themselves, which can lead to low self-esteem and the feeling of being unwanted. Neglect is more severe in younger children when it comes to psychological consequences.
Child abuse or child maltreatment is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential harm to a child and can occur in a child’s home or in the organizations, schools, or communities the child interacts with.
The terms child abuse and child maltreatment are often used interchangeably, although some researchers make a distinction between them, treating child maltreatment as an umbrella term to cover neglect, exploitation, and trafficking.
Child abuse can result in immediate adverse physical effects but it is also strongly associated with developmental problems and with many chronic physical and psychological effects, including subsequent ill-health, including higher rates of chronic conditions, high-risk health behaviors, and shortened lifespan. Children who have a history of neglect or physical abuse are at risk of developing psychiatric problems or a disorganized attachment style. In addition, children who experience child abuse or neglect are 59% more likely to be arrested as juveniles, 28% more likely to be arrested as adults, and 30% more likely to commit a violent crime. Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as anxiety, depressive, and acting out symptoms. A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms of disorganized attachment. When some of these children become parents, especially if they suffer from PTSD, dissociative symptoms, and other sequelae of child abuse, they may encounter difficulty when faced with their infant and young children’s needs and normative distress, which may in turn lead to adverse consequences for their child’s social-emotional development.
Housing and Poverty Problems
Housing inequality is a disparity in the quality of housing in a society that is a form of economic inequality. The right to housing is recognized by many national constitutions, and the lack of adequate housing can have adverse consequences for an individual or a family. The term may apply regionally (across a geographic area), temporally (between one generation and the next) or culturally (between groups with different racial or social backgrounds). Housing inequality is directly related to racial, social, income, and wealth inequality. It is often the result of market forces, discrimination, and segregation.
Housing inequality and poverty may lead to anxiety and depression, among other psychological disorders, due to constant stressors. Housing inequality is also a cause and an effect of poverty. The results of one study found that people who thrive with financial stability or fall under low SES, tend to perform worse cognitively due to external pressure imposed upon them. The research found that stressors such as low income, inadequate health care, discrimination, and exposure to criminal activities all contribute to mental disorders. This study also found that it slows cognitive thinking in children when they are exposed to poverty-stricken environments. In kids, it is seen that kids perform better under the care and nourishment from their parents, and found that children tend to adopt speaking language at a younger age. Since being in poverty from childhood is especially more harmful than it is for an adult, it is seen that children in poor households tend to fall behind in certain cognitive abilities compared to other average families.
Disparities in housing explain variations in the conversion of income into human capabilities in different social climates. Income does not always translate into desirable outcomes such as health care, education, and housing quality. According to economist and philosopher Amartya Sen, an individual’s freedoms (or capabilities) are significant indicators of the kind of life they value or have a reason to value. As economic equality varies by the economic system, historical period, and society, so does housing inequality. Economic inequality is a primary contributing factor to housing inequality. The distribution of wealth in a region affects who has access to housing and at what level.
Social inequality is the difference in access to social goods brought about by social constructs such as power, religion, kinship, prestige, race, ethnicity, gender, age, and class. Social goods include the labor market, a source of income, healthcare, freedom of speech, education, and political representation and participation. Social inequality may be a factor of housing inequality, as when individuals are denied access to housing based on social characteristics. Conversely, social inequality can be a result of housing inequality (such as social stigma associated with living in a certain neighborhood or type of home).
The most direct effect of housing inequality is an inequality of neighborhood amenities, which include the condition of surrounding houses, the availability of social networks, the amount of air pollution, the crime rate, and the quality of local schools. A neighborhood with a certain quality of amenities typically includes individual residences of corresponding quality. Those with lower incomes usually live in areas with poor amenities to win the spatial competition for housing. A neighborhood amenity includes satisfaction derived from living in a nice area, and many studies suggest that growing up in a high-poverty neighborhood affects social and economic outcomes later in life.
Another way the poor compete for housing is by renting homes rather than owning them, which furthers the negative effects of housing inequality by restricting access to household wealth. Although the focus of housing inequality has changed with time, contemporary international analyses tend to center on urbanization and the move to metropolitan areas. International housing inequality is largely characterized by urban disparities.
In developing countries, housing inequality is increasingly caused by rural-to-urban migration, increasing urban poverty and inequality, insecure tenure, and globalization. All these factors contribute to the creation and continuation of slums in poorer areas of the world. One proposed solution is slum upgrading.
These market forces are subject to other socio-economic factors; no one cause can explain housing inequality. In the United States, Thomas Shapiro and Jessica Kenty-Drane point to the wealth gaps between African Americans and other groups as likely causes of the housing disparity between African Americans and the rest of the country. According to Shapiro and Kenty-Drane, historical and social obstacles (slavery and racial segregation) have prevented African Americans from securing and accumulating assets including quality housing. Yinger also suggests that racial discrimination still plays a role in housing; Black and Latino households must pay higher search costs, accept lower-quality housing ,and live in lower-quality neighborhoods due to discrimination. One study found that 20% of potential moves made by African-American households and 17% of potential moves made by Latino households were discouraged by discrimination in the search process.
Social Environment Problems
The social environment, or social context, refers to the immediate physical and social setting in which people live or in which something happens or develops. The social environment includes the culture that the individual was educated or lives in and the people and institutions with whom they interact. The interaction may be in person or through communication media, even anonymous or one way, and may not imply equality of social status. The social environment is a broader concept than that of social class or social circle. People with the same social environment often develop a sense of social solidarity; people often tend to trust and help one another, and to congregate in social groups. People will often think in similar styles and patterns, even though the conclusions which they reach may differ.
In sociology and social psychology, racial identity and the acquisition of that identity is often used as a variable in racism studies. Racial ideologies and racial identity affect individuals’ perception of race and discrimination. Cazenave and Maddern (1999) define racism as “a highly organized system of ‘race’-based group privilege that operates at every level of society and is held together by a sophisticated ideology of color/’race’ supremacy. Racial centrality (the extent to which a culture recognizes individuals’ racial identity) appears to affect the degree of discrimination African American young adults perceive whereas racial ideology may buffer the detrimental emotional effects of that discrimination.” Sellers and Shelton (2003) found that a relationship between racial discrimination and emotional distress was moderated by racial ideology and social beliefs.
Some sociologists also argue that, particularly in the West, where racism is often negatively sanctioned in society, racism has changed from being a blatant to a more covert expression of racial prejudice. The “newer” (more hidden and less easily detectable) forms of racism—which can be considered embedded in social processes and structures—are more difficult to explore as well as challenge. It has been suggested that, while in many countries overt or explicit racism has become increasingly taboo, even among those who display egalitarian explicit attitudes, an implicit or aversive racism is still maintained subconsciously.
This process has been studied extensively in social psychology as implicit associations and implicit attitudes, a component of implicit cognition. Implicit attitudes are evaluations that occur without conscious awareness towards an attitude object or the self. These evaluations are generally either favorable or unfavorable. They come about from various influences in the individual experience. Implicit attitudes are not consciously identified (or they are inaccurately identified) traces of past experience that mediate favorable or unfavorable feelings, thoughts, or actions towards social objects. These feelings, thoughts, or actions have an influence on behavior of which the individual may not be aware.
Some mental disorders are unique to specific cultures; while they may share similarities with others mentioned in the DSM-5, these disorders are only considered recognizable within their respective cultures. In the DSM-4, these were called culture-bound syndromes, but are now identified in the DSM-5 as cultural concepts of distress. Some of these cultural concepts of distress are described below:
|Ataque de nervios||Commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising into the head, and verbal or physical aggression. Dissociative experiences, seizure-like or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Ataques de nervios frequently occur as a direct result of a stressful event relating to the family (e.g., death of a close relative, separation or divorce from a spouse, conflict with spouse or children, or witnessing an accident involving a family member). People can experience amnesia for what occurred during the ataque de nervios, but they otherwise return rapidly to their usual level of functioning. Although descriptions of some ataques de nervios most closely fit with the DSM-4 description of panic attacks, the association of most ataques with a precipitating event and the frequent absence of the hallmark symptoms of acute fear or apprehension distinguish them from panic disorder. Ataques range from normal expressions of distress not associated with a mental disorder to symptom presentations associated with anxiety, mood dissociative, or somatoform disorders.||Caribbean, Latin American, Latin Mediterranean|
|Dhat (jiryan in India, skra prameha in Sri Lanka, shen-k’uei in China)||A folk diagnosis for severe anxiety and hypochondriacal concerns associated with the discharge of semen, whitish discoloration of the urine, weakness, and exhaustion.||Asian Indian|
|Nervios||Refers both to a general state of vulnerability to stress and to a syndrome evoked by difficult life circumstances. Nervios includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and “brain aches,” irritability, stomach disturbances, sleep difficulties, nervousness, tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigo-like exacerbations). Nervios tends to be an ongoing problem, although it is variable in the degree of disability manifested. Nervios is a broad syndrome that ranges from cases free of a mental disorder to presentations resembling adjustment, anxiety, depressive, dissociative, somatoform, or psychotic disorders. Differential diagnosis depends on the constellation of symptoms, the kind of social events associated with onset and progress, and the level of disability experienced.||Latin American|
|Shenjing shuairuo||A condition characterized by physical and mental fatigue, headaches, difficulty concentrating, dizziness, sleep disturbance, and memory loss. Other symptoms include gastrointestinal problems, sexual dysfunction, irritability, excitability, and autonomic nervous system disturbances.||Chinese|
|Susto (espanto, pasmo, tripa ida, perdida del alma, or chibih)||An illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Individuals with susto also experience significant strains in key social roles. Symptoms can appear days or years after the fright is experienced. In extreme cases, susto can result in death. Typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep or dreams, sadness, lack of motivation, and feelings of low self-worth or dirtiness. Somatic symptoms accompanying susto include muscle aches and pains, headache, stomachache, and diarrhea. Ritual healings focus on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance. Susto can be related to major depressive disorder, posttraumatic stress disorder, and somatoform disorders. Similar etiological beliefs and symptom configurations are found in many parts of the world.||Latino American, Mexican, Central and South American|
|Taijin kyofusho||This syndrome refers to an individual’s intense fear that their body, its parts, or its functions displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movement. This syndrome is included in the official Japanese diagnostic system for mental disorders.||Japanese|
abuse: the improper usage or treatment of a person, often to unfairly or improperly gain benefit
child abuse: physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver
housing inequality: a disparity in the quality of housing in a society; a form of economic inequality
neglect: a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so
social environment: the immediate physical and social setting in which people live or in which something happens or develops
- Sleek, Scott (31 August 2015). "How Poverty Affects the Brain and Behavior". APS Observer. 28 (7). ↵
- Center for Substance Abuse Treatment (US). Improving Cultural Competence. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 59.) [Table], DSM-5 Cultural Concepts of Distress. Available from: https://www.ncbi.nlm.nih.gov/books/NBK248426/table/appe.t1/ ↵