What Is A Psychiatrist? Definition And Overview Of Areas Of Specialization
Updated February 09, 2020
Reviewer Whitney White, MS. CMHC, NCC., LPC
Among the numerous benefits of seeking help for mental health concerns is that it opens the door for treatment, support, and a better quality of life. Some persons are unsure, however, where to turn for help. The good news is that there are many avenues available to you if you need assistance in dealing with a mental health issue. One of those options is psychiatric care.
But exactly what do psychiatrists do and what are the different areas of mental health they are qualified to assist in? To answer those questions, we will take an in-depth look at psychiatrists: definition, training, skills, services they offer, where they work, and the different fields of psychiatry in which they specialize.
By equipping yourself with this knowledge, you will be better able to take control of your mental health.
Definition of Psychiatrist
To gain a full understanding of who a psychiatrist is, let us look at definitions given by five trusted sources.
- The American Psychiatric Association (APA) defines a psychiatrist as:
"A medical doctor who specializes in mental health, including substance use disorders."
The APA goes on to clarify that a psychiatrist can "assess both the mental and physical aspects of psychological problems."
- The National Cancer Institute at the National Institutes of Health gives the following definition of a psychiatrist:
"A medical doctor who has special training in preventing, diagnosing, and treating mental, emotional, and behavioral disorders."
- The United States Department of Labor's Bureau of Labor Statistics (BLS) defines the psychiatrist as a "primary mental health physician" who, through a blend of approaches can "diagnose and treat mental illnesses." It lists the following as types of therapy the psychiatrist might use: "psychotherapy, psychoanalysis, hospitalization, and medication."
- The UK's Royal College of Psychiatrists' describes a psychiatrist as "a medically-qualified practitioner." It goes on to outline the more than 12 years of training that the psychiatrist receives, culminating with a minimum of 6 years "training in helping people with psychological problems."
- The Royal Australian and New Zealand College of Psychiatrists also points to the medical training which psychiatrists must first receive. It then describes the psychiatrist as having:
"A deep understanding of physical and mental health - and how they affect each other."
Putting all these definitions together, we see the psychiatrist as a highly trained medical doctor who focuses not only on mental disorders but on emotional and behavioral issues, as well. The psychiatrist is trained in diagnosing these issues and has a range of treatment options to select from in dealing with them. Apart from diagnosis and treatment, the psychiatrist is also involved in implementing preventative measures to guard against the mental issues arising or recurring.
What Do Psychiatrists Do?
There is a range of functions which psychiatrists carry out to best assist patients who come under their care. Before diagnosing the nature or extent of a patient's mental disorder and deciding what course of action to take, psychiatrists must refer to the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It contains specific criteria to be checked such as descriptions and symptoms of mental disorders.
A psychiatrist designs a specific treatment plan to meet the needs of the individual patient. The treatment may be administered by the psychiatrist or by someone else under their direction and guidance. Among these treatments is medication which the psychiatrist can prescribe to be used either as the main course of treatment or in conjunction with other therapies.
Psychiatrists also engage in medication management where a good deal of time is spent with the patient ensuring that the prescribed medication is not only appropriate for their condition but is being used in an effective and safe way.
Psychotherapy is another form of therapy which psychiatrists have at their disposal to use if it is deemed appropriate for a patient's condition. Types of psychotherapy include goal-oriented cognitive-behavior therapy in which the main aim is helping the patient to find solutions or coping strategies for their mental health issue. There is also psychoanalysis which is intensive individualized psychotherapy normally lasting several years. Each of these therapies requires additional training on the part of the psychiatrist. Due to a shortage of psychiatrists in the United States, many psychiatrists refer patients to licensed professional counselors and therapists to receive psychotherapy.
Psychiatrists also administer various forms of physical therapy, including:
- Electroconvulsive therapy (ECT) - Used particularly in the case of severe depression. ECT, which involves the application of electrical currents to the brain, is generally only used when other forms of therapy have not been effective.
- Deep brain stimulation (DBS) - A form of neurosurgery used in cases of Parkinson's Disease, dystonia, obsessive-compulsive disorder (OCD), and epilepsy.
- Vagus nerve stimulation (VNS) - Electrical stimulation of the vagus nerve in the brain to treat epilepsy and major depressive disorder when medication and other treatments prove to be ineffective.
- Transcranial magnetic stimulation (TMS) - Use of an electromagnetic coil to deliver repetitive magnetic pulses to the brain. This stimulates the central nervous system as a treatment for depression.
- Light therapy - Used to treat seasonal affective disorder, depression, and sleep disorders.
Routine parts of the psychiatrist's job include gathering patient data and keeping updated records of patients' medical history. They can also help patients and their families to cope with stress and crises which may be directly related to the mental issue the patient is dealing with.
Psychiatrists also have the job of advising a patient's spouse, guardian, family members and caregivers on their condition, treatment, and needs. They will consult and work with a patient's primary care physician, as well as licensed therapists and case managers who are involved in patient treatment. The psychiatrist may also refer patients to other primary healthcare workers.
What Kind of Training Do Psychiatrists Undergo?
According to the APA, to become a psychiatrist, one must first complete medical school, the last two years of which exposes students to six sub-specialties, including psychiatry. Completion of medical school earns the aspiring psychiatrist abbreviations of either M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine) behind their name.
The doctor then spends at least four years in residency specializing in psychiatry. At the end of this time, they can apply to the American Board of Psychiatry and Neurology for board certification as a psychiatrist. It will take a few more years of subspecialty training if they wish to specialize in a particular area of psychiatry.
What Conditions Can Be Diagnosed and Treated by A Psychiatrist?
Psychiatrists will ordinarily treat serious mental health issues. Some of these conditions are severe depression, schizophrenia, and bipolar disorder. Psychiatrists may work with persons who are having suicidal thoughts or have attempted suicide.
Here are some of the many other conditions which a day in the life of a psychiatrist might involve treating:
- Depression and bipolar disorder
- Neurodevelopmental disorders
- Personality disorders
- Sexual dysfunction
- Post-traumatic stress disorder (PTSD)
- Dementia and Alzheimer's disease
- Feeding and eating disorders, such as anorexia and bulimia
- Sleep disorders, such as insomnia
- Substance use and addictive disorders
- Psychotic disorders
- Dissociative disorders
- Elimination disorders
- Sleep-wake disorders
- Gender dysphoria
- Paraphilic disorders
Psychiatrists also have the expertise to determine whether a physical issue such as a hormonal imbalance or a negative reaction to medication is causing the patient's mental health woes. Conversely, they can also ascertain if there is an underlying mental health or psychological issue which is causing physical symptoms experienced by the patient.
Most importantly, through their expertise and experience, psychiatrists can form a trusting relationship with you - one built on confidentiality and mutual respect.
Where Do Psychiatrists Work?
Psychiatrists can be found working throughout the public and private health sector, delivering their services to individuals, couples, families, and groups in face-to-face settings, or via the internet. Apart from psychiatric and general hospitals, the APA lists the following as some of the places you can expect to find psychiatrists working:
- Courts and prisons
- Nursing homes
- Emergency rooms
- Government and military settings
- Community hospitals
- State and federal hospitals
- Community mental centers
It also reveals that, while it is not uncommon for a psychiatrist working in several different settings, approximately half of the roughly 45, 000 psychiatrists in America work in private practice.
Similar information is provided by the BLS which also indicates that the highest number of psychiatrists working in private practice. It highlights other top areas of employment for psychiatrists as Psychiatric and Substance Abuse Hospitals; General Medical and Surgical Hospitals; and Outpatient Care Centers.
Can A Psychiatrist Prescribe Medication?
As medically trained physicians, psychiatrists can prescribe medication to their patients based on their assessment of their patients' needs. In fact, prescribing medication is one of the major functions of a psychiatrist who will often use medication along with psychotherapy in a combined approach to a patient's mental health issue.
The ability to prescribe is often cited as one of the major differences between a psychiatrist and a psychologist. Psychologists typically cannot prescribe medication and must refer patients whom they feel need medication for a mental or behavioral issue to a psychiatrist.
It is important to note here that there a few states which do allow psychologists limited authority to prescribe certain medications but only after they have completed specific courses and training in pharmacology.
Areas of Specialization Within Psychiatry
Some psychiatrists choose to practice general psychiatry while others go on to pursue further training and certification in a particular area of specialization of psychiatry. Some of these are:
Addiction Psychiatry deals with addiction disorders and covers a long list of things to which the individual might become addicted. Common examples are food, sex, illegal drugs, legal drugs, alcohol, tobacco, pornography, the internet, video gaming, shopping, and gambling.
The Addiction Psychiatrist treats patients individually as well as in groups, assessing each patient to determine their treatment needs. They also work with the family members of the addicted person to come up with a supportive rehabilitation framework, including measures which can help to prevent them from reverting to their dependence on whatever it is they were addicted to.
Addiction Psychiatrists often work in rehabilitation facilities, particularly those focused on helping persons overcome substance abuse. They can also be found in various out-patient clinics and a wide variety of both public and private settings. Addiction Psychiatrists are currently in short supply, and so demand for their service is high.
Child and Adolescent Psychiatry
Also called Pediatric Psychiatry, Childhood and Adolescent Psychiatry aims to treat children and teenagers who have mental health concerns while taking their stage of development, family history, and social interactions into consideration. As a result, a psychiatrist in this field has plenty of contact with family members and caregivers of the patient. On occasion, they may also need to include the patient's peers and teachers in their method of treatment.
Common issues dealt with by the Child, and Adolescent Psychiatrist includes learning disabilities; coping with changing moods; anxiety disorders; sex and sexually transmitted infections; eating disorders; substance abuse; handling peer pressure; and the transition from childhood to adulthood.
Medication is one therapy option open to the Child and Adolescent Psychiatrist, but other methods include Cognitive Behavior Therapy and Problem-Solving Therapies. A psychiatrist may also refer patients and family members to other support like individual therapies, group therapy, and other services offered by licensed therapists or social workers.
The mental health issues which are typically found in elderly patients are dealt with in Geriatric Psychiatry. Among these are sleep disorders; depression; late onset substance abuse; and particularly, dementia (loss of cognitive function). The most common form of dementia which psychiatrists treat is Alzheimer's disease which accounts for up to 70% of all dementia patients.
The Geriatric Psychiatrist must also deal with emotional disorders which arise out of the patient having to deal with issues related to old age. These include stress brought on by a change in surroundings, most often from being placed in a care facility; chronic pain; and mounting physical ailments.
Improvements in life expectancy mean most developing countries now have an aging population. This has led to the projection of a vast increase in the demand for Geriatric Psychiatrists in the future. Currently, numerous job opportunities for Geriatric Psychiatrists already exist in the growing number of assisted living facilities, nursing homes, and private practice.
Forensic (Legal) Psychiatry
Forensic Psychiatry involves working within the court system and with government agencies to determine the mental health of witnesses, suspects, and inmates. Forensic Psychiatrists are often called upon to carry out evaluations of inmates who are seeking probation and determining whether an inmate's mental state makes them a danger to themselves or those around them.
The Forensic Psychiatrist is often used as an expert witness in criminal cases to say whether someone is competent to stand trial or to give evidence. There may also be the issue of determining a suspect's mental state at the time they committed an offense.
In civil cases, the Forensic Psychiatrist's job involves assessing the extent of medical health injuries and deciding on a patient's mental competency so the court can make a ruling on guardianship.
The field of Forensic Psychiatry has led to the development of other areas of specialization, including:
- Adolescent Forensic Psychiatry
- Forensic Learning Disability Psychiatry
- Forensic Psychotherapy
Biological Psychiatry (or Biopsychiatry) deals with the physical basis of mental disorders, with a focus on the nervous system and brain chemistry. As such, it is less likely to use psychotherapy and more likely to treat a patient's mental disorder with medication or physical approaches, such as light therapy, electrical brain stimulation, exercise, and dietary adjustment. It must be noted, however, that quite often both psychotherapy and biological approaches are used in tandem.
Conditions which are usually treated by a Biopsychiatrist include psychotic disorders, such as schizophrenia and bipolar disorder; depression; attention deficit hyperactivity disorder (ADHD); eating disorders; and substance abuse.
Before diagnosing the patient's condition as a mental health issue, the Biopsychiatrist will attempt to eliminate other possible biological reasons for their symptoms. For instance, what may at first appear as psychosis could, in fact, be the body's reaction to low blood sugar levels (hypoglycemia). Also, a malfunctioning thyroid gland may cause a patient to appear as if they are experiencing a major depressive episode (MDE).
Organizational and Occupational Psychiatry
This field of psychiatry deals with the client's interactions within the workplace. It takes into consideration the mental state the client brings to the workplace and the effect the workplace has on the client's mental state.
Organizational and Occupational Psychiatrists may be required to identify, assess and treat employees for work-related stress and its manifestations, such as hypertension. They may also be asked to assess the mental health of someone who is in line for a promotion to an executive level position. Another of their jobs may be doing assessments for disability insurance benefits.
Psychiatrists in this area are in growing demand as companies are becoming more cognizant of the benefits of preventative psychiatric measures for their workers. Organizational and Occupational Psychiatrists are also key contributors to the development of company policy and procedures. The field of Organizational and Occupational Psychiatry is still in the early stages of development, and as such, there is plenty of room for practitioners to focus solely on research if they so desire.
Sleep Medicine has evolved as an area of specialization within several branches of medicine, including psychiatry. It involves the diagnosis and treatment of sleep disorders such as insomnia, restless leg syndrome, narcolepsy, and obstructive sleep apnea.
Psychiatrists who practice Sleep Medicine will look at the amount and quality of sleep a patient gets and how this affects their mental state and ability to function in daily life. They will be on the lookout for other conditions which tend to coexist with sleep issues. These include:
- Heart disease
- Congestive heart failure
- Parkinson's disease
This area of specialization involves psychiatrists working in various emergency settings, including the emergency rooms of hospitals. One challenge for Emergency Psychiatrists is that they work with patients who are in immediate and acute danger due to their mental state.
It is not uncommon for Emergency Psychiatrists to be called upon in cases of acute withdrawal symptoms in someone with a substance abuse issue; extreme intoxication; preventing a suicide attempt; and medical complications due to a patient's mental health.
Another of their challenges is that, unlike most other psychiatrists who can build relationships with their patients over time, Emergency Psychiatrists are almost always dealing with a unique patient every time.
The British Association for Psychopharmacology describes Psychopharmacology as "the study of drugs that affect mood, behavior, and cognition." Strictly speaking, Psychopharmacology is not an area of specialization of psychiatry but, thanks to their training, it is a field of medicine in which psychiatrists have the unique ability to excel.
Psychopharmacologists conduct research into how psychoactive drugs work, how they interact with each other and how they may be used to treat mental disorders. They are also concerned with the ways in which such drugs might be abused. Substances studied by psychopharmacologists include alcohol, stimulants, opioids, hallucinogens, antidepressants, and cannabis.
Mental health has been heavily stigmatized in the past, but there is a new and growing realization that openness about mental health issues carries numerous benefits. If you feel like discussing your mental health concerns with a psychiatrist, you can ask for a referral from your primary doctor or check your area for psychiatrists. Starting with psychotherapy can be done online, from the convenience of your home, by visiting BetterHelp where you'll find thousands of licensed professional therapists with master's degrees and higher to assist you.