Ethnic and racial group differences in help-seeking are a barrier to the effective and equitable delivery of mental health services. Asian American populations demonstrate relatively low levels of help-seeking. Explanations for this effect typically point to elevated levels of stigma in these populations. An alternative explanation is that low help-seeking might also reflect holding a relatively circumscribed concept of mental disorder. Individuals and groups with less inclusive concepts of disorder may be less likely to identify problems as appropriate for mental health treatment. This study aimed to test whether group differences in the breadth of the mental disorder concept account for group differences in help-seeking attitudes. A sample of 212 American participants (102 Asian Americans and 110 White Americans) were assessed on personal stigma, help-seeking attitudes, and mental disorder concept breadth. Mediation analyses examined whether stigma and concept breadth mediated group differences in attitudes. Compared to White Americans, Asian Americans reported higher levels of stigma and narrower concepts of mental disorder, both of which were associated with less positive help-seeking attitudes. Stigma and concept breadth both partially mediated the group difference in attitudes. Theoretical and practical implications for mental health promotion and culturally sensitive clinical practices are explored.

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.

Some aspects of psychiatrization can be understood as forms of concept creep, the progressive expansion of concepts of harm. This article compares the two concepts and explores how concept creep sheds light on psychiatrization. We argue that although psychiatrization is in some respects a broader concept than concept creep, addressing institutional and societal dimensions of the expanding reach of psychiatry in addition to conceptual change, concept creep is broader in other respects, viewing the expansion of psychiatric concepts as examples of the broadening of a more extensive range of harm-related concepts. A concept creep perspective on psychiatrization clarifies the different forms of expansion it involves, the centrality of harm to it, its benefits as well as its costs, its variations across individuals and groups, and the drivers of psychiatrization in the general public and in fields beyond psychiatry.