Do the Words Matter?: The Language We Use for Mental Health
Several general terms used to describe mental disorders are understood by most people to have similar meanings, according to a new study published in BMC Psychiatry. However, with specific mental disorder concepts and terms, the study found some differences between public perceptions and the descriptions in the Diagnostic and Statistical Manuu56a5l of Mental Disorders (DSM). The DSM is the handbook published by APA and used by healthcare professionals in the U.S. and much of the world as the authoritative guide to the diagnosis of mental disorders. The latest edition is the DSM, Fifth Edition, Text Revision (DSM-5TR), published in 2022. See more on the DSM.
Concepts and classification of mental disorders have been the focus of significant attention, but how the concepts and terms are understood by laypeople, the study authors note, has received much less attention.
Researchers Jesse S. Y. Tse and Nick Haslam, Ph.D., with the University of Melbourne, examined public perceptions about various general labels for mental disorders and found that “mental disorder,” “mental illness,” and “mental health problem” were viewed with very similar meanings. “Psychological issue” was viewed as encompassing a broader range of conditions.
The study involved a nationally representative sample of 600 adults in the U.S. Subsets of participants were asked to review and make judgments about vignettes describing people with mental disorders. The vignettes covered 37 DSM-5 disorders and 24 non-DSM phenomena. Examples of non-DSM conditions examined in the study include character flaws (such as recurrent cheating and jealousy); bad habits (such as procrastination and social media disorder); and medical/neurological conditions (such as migraine headaches and multiple sclerosis). DSM-5 conditions included disorders from each of the 19 broad categories (such as depressive disorders, anxiety disorders, dissociative disorders, bipolar and related disorders). Each vignette was two to five sentences long describing an unnamed fictitious person who might or might not have a mental disorder. Demographic information was only included when necessary as part of the diagnostic criteria.
When looking at perceptions of disorders in relation to definitions in the DSM-5, Tse and Haslam found “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.” People tended to judge whether a condition is a mental disorder primarily based on whether it is associated with emotional distress and impairment, and that it is rare and aberrant, according to the authors.
Among the DSM-5 disorders that study participants were less likely to view as disorders were somatic symptom disorder, insomnia, restless leg syndrome and caffeine withdrawal disorder. Among the conditions participants identified as disorders that are not recognized in DSM-5 were suicidal behavior disorder, internet gaming disorder and social media disorder.
Another recent study similarly found that terminology had little impact on stigma. Researchers Annie B. Fox, Ph.D., and colleagues surveyed 3,367 people with a current or past history of mental illness. They were randomly assigned to 5 different labels: “mental illness,” “mental health problem,” “psychological disorder,” “emotional distress,” and the choice of their own term and then asked to respond to questions about stigma and mental health that used the assigned terms. The researchers found no differences in the level of stigma across the terms with the exception of emotional distress. Those in the emotional distress group reported significantly higher personal, perceived, and internalized stigma compared to the other terms. When allowed to choose their own term, “mental illness” was selected most frequently.
The authors of both studies suggest that local, cultural, and historical context be considered in making decisions about appropriate terms.
- Tse, J.S.Y., Haslam, N. What is a mental disorder? Evaluating the lay concept of Mental Ill Health in the United States. BMC Psychiatry 23, 224 (2023). https://doi.org/10.1186/s12888-023-04680-5
- Fox AB, et al. Mental illness, problem, disorder, distress: does terminology matter when measuring stigma? Stigma and Health. 2021;6(4):419–29.
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787