Additional Conditions That May Require Clinical Attention

What follows below is a long list of problems that don't quite fit any category of mental disorder, but which nevertheless may demand clinical attention. We will make very brief comments on each condition, with the understanding that the condition must have caused enough distress for someone--not necessarily the person being attended to--to have gotten the person referred for examination and possible treatment.

Noncompliance with treatment: This simply means that the person is not following a prescribed treatment routine for either a mental disorder or a medical condition. In some cases noncompliance is life-threatening; an example might be when a diabetic is letting his or her blood sugar level go far out of control because of refusal to monitor diet or take medication. 

Malingering: People who malinger are pretending to have a medical or mental problem for the sake of external gain, usually from an insurance company. They differ from patients with Factitious Disorder in that the latter obtain their reward from the sick role itself. Malingerers sometimes have Antisocial Personality Disorder, and in any case are not likely to cooperate with an examination or treatment regime. 

Adult antisocial behavior: Adult antisocial behavior differs from Antisocial Personality in that no mental disorder is present; the person simply engages in antisocial behavior, for example in robbery or drug dealing.

Child or adolescent antisocial behavior: Same as above, but in a younger person.

Borderline intellectual functioning: This can be diagnosed when the individual's IQ is just above the range for Mental Retardation, that is, from just above the usual cutoff at 70 up to the low normal range beginning at about 85. 

Age-related cognitive decline: This category is for normal people who are upset about the cognitive decline that usually attends very old age; the person may be unable to remember names or retrieve words that they knew very well. Treatment cannot reverse the decline, but may be helpful in dealing with it more effectively, both emotionally and in carrying out the tasks associated with daily life. 

Bereavement: This all-too-familiar problem is faced by everyone who lives long enough to lose family members to death. Bereavement is sometimes difficult to distinguish from Major Depressive Disorder; their symptoms may be nearly identical, and in fact bereavement may precipitate a Major Depressive Disorder. The latter diagnosis, rather than Bereavement, may be correct if the symptoms are more severe than normal, last longer than 2 months, or include feelings of guilt and worthlessness, hallucinations, and thoughts of death that go beyond what would normally be expected in a bereaved person. Because distinguishing the diagnoses is difficult, the best clinical strategy may be to assume that the person is simply bereaved until failure to improve demonstrates that a Major Depressive Disorder was precipitated. 

Academic problem: If the student has an academic problem with no other apparent cause, then this diagnosis should be made and the problem treated directly. However, it is especially important with this age group to be sure that the problem does not derive from a Learning Disorder (these used to be called Academic Skills Disorders), a substance abuse problem, an Adjustment Disorder, or another mental disorder. 

Occupational problem: This could be a problem at work or a "What am I going to do with my life?" problem.

Identity problem: Identity problems are not completely distinct from occupational problems; however, identity problems encompass more areas of life, and could concern such questions as "Who am I? What are my life goals? What do I believe in?"

Religious or spiritual problem: This could include anything from emotional trauma after losing belief in the religion of one's childhood to problems of adjusting to a new religion after converting from an earlier belief system. 

Acculturation problem: Such problems derive from moving into a new culture; the related issues require unusual cultural sensitivity on the parts of clinicians who are trying to help people adjust better to a new life. 

Phase of life problem: A good example of this type of problem is the "midlife crisis" problem, a well-known problem that may or may not exist. Problems in adapting to old age might be a less controversial example. 

Unspecified mental disorder: And finally, to cap off all mental disorders, a final miscellaneous category to provide a place for all people who have something wrong, but we can't figure out what it is. This category should remind us that people are all individuals, and each has a unique version of whatever problem brings them to clinical attention. It is only fitting that psychiatrists have given us a category recognizing the fact that fitting people into categories can never quite encompass all of this uniqueness! 

                                                                                                                                Last updated  12/19/03