Certain conditions may be the focus of clinical attention leading to contact with the mental health care system but lack sufficient evidence for a diagnosis. Sometimes these conditions may be noted during the course of a psychiatric evaluation even though no mental disorder has been found. Other times there is a need to note the primary reasons for contact with the mental health care system even though diagnostic evaluation reveals no mental disorder. A mental disorder may eventually be found, but the focus of attention is on a condition that is not caused by a mental disorder. For example, a patient with an anxiety disorder may receive treatment for a marital problem that is unrelated to the anxiety disorder itself.

Thirteen conditions make up the category of additional conditions that may be a focus of clinical attention: malingering, bereavement, occupational problems, adult antisocial behavior, religious or spiritual problem, acculturation problem, phase-of-life problem, noncompliance with treatment for a mental disorder, academic problem, identity problem, age-related cognitive decline, borderline intellectual functioning, and child or adolescent antisocial behavior.

Malingering is the intentional production of false or overly exaggerated physical or psychological symptoms motivated by external gains. Clinically, it is often crucial to distinguish malingering from true mental illnesses such as factitious, somatoform, or dissociative disorders. Malingering may be associated with child, adolescent, or adult antisocial behavior, which is characterized by engaging in illegal or immoral activities. However, the antisocial behavior in these conditions never reaches the level necessary to diagnose an antisocial personality disorder.

Bereavement is a condition that can become the focus of clinical attention even if it does not progress to the outright acute mental disorder of depression. Clinicians must be aware of the difference between normal bereavement and depression and be alert for the development of more serious symptoms.

Examples of an occupational problem include job dissatisfaction and uncertainty about career choices. A phase-of-life problem might be associated with such major life-cycle changes as starting college, getting married, or having children. Stress during times of cultural transitions, such as moving to a new country or entering the military, can lead to an acculturation problem. Young people who join cults might provide examples of religious or spiritual problems. Age-related cognitive decline must be distinguished from dementia, and borderline intellectual functioning must be distinguished from diagnosable developmental delays or specific learning disorders. Academic problems, identity problems, and noncompliance with treatment are the remaining conditions addressed in this chapter, and students should be able to describe and recognize their characteristics.

Students should study the questions and answers below for a useful review of these conditions.