What is necessary to determine if a person may have a psychological disorder?

While the concept of mental or psychological disorders is difficult to define, and no definition will ever be perfect, it is recognized as an extremely important concept and therefore psychological disorders (aka mental disorders) have been defined as a psychological dysfunction which causes distress or impaired functioning and deviates from typical or expected behavior according to societal or cultural standards. This definition includes three components (3 Ds)

• Dysfunction
• Distress
• Deviance

Dysfunction includes disturbances in a person’s thinking, emotional regulation, or behavior that reflects significant dysfunction in psychological, biological, or developmental processes underlying mental functioning. In other words, dysfunction refers to a breakdown in cognition, emotion, and/or behavior. For instance, an individual experiencing the delusion that he is an omnipotent deity has a breakdown in cognition because his thought processes are not consistent with reality. An individual who is unable to experience pleasure has a breakdown in emotion. Finally, an individual who is unable to leave her home and attend work due to fear of having a panic attack is exhibiting a breakdown in behavior.

Distress can take the form of psychological or physical pain, or both at the same time. Simply put, distress refers to suffering. Alone though, distress is not sufficient enough to describe behavior as abnormal. Think about it – the loss of a loved one causes even the most “normally” functioning individual pain and suffering. An athlete who experiences a career ending injury would display distress as well. Suffering is part of life and cannot be avoided. Impairment refers to when the person experiences a disabling condition that limits the ability to engage in activities of daily living (e.g., can no longer maintain minimum standards of hygiene, pay bills) or participate in social events (e.g., attending social events), work or school. Impairment can also interfere with the ability to perform important life roles (e.g., student, caregiver or parent).

A closer examination of the word abnormal shows that it indicates a move away from what is normal, typical, or average. Deviance refers to behavior that violates social norms or cultural expectations because culture determines what is normal. When a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms. As you might expect there is a lot of cultural variation in acceptable behavior.

Earlier we learned about cultural relativism and what is considered normal by a culture can change over time due to shifts in accepted values and expectations. For instance, just a few decades ago homosexuality was considered taboo in the United States and it was included as a mental disorder in the first edition of the DSM; but today, it is generally accepted. Likewise, public displays of affection do not cause a second look by most people unlike the past when these outward expressions of love were restricted to the privacy of one’s own house or bedroom. In the United States, crying is generally seen as a weakness for males but if the behavior occurs in the context of a tragedy then it is appropriate and understandable. Finally, consider that statistically deviant behavior is not necessarily negative. Cognitive genius is an example of behavior that is not the norm. Abnormality alone is not an indication of a disorder or problem.

Though not part of the DSM -5 conceptualization of what abnormal behavior is, many clinicians add a fourth D – dangerousness to this list. Dangerousness refers to when behavior represents a threat to the safety of the person or the safety of others. Individuals expressing suicidal intent, those experiencing acute paranoid ideation combined with aggressive impulses (e.g., wanting to harm people who are perceived as being out to get them), and many individuals with antisocial personality disorder may be considered dangerous. Mental health professionals (and many other professionals including researchers) have a duty to report to law enforcement when an individual expresses an intent to harm themselves or others. Individuals with depression, anxiety, and obsessive-compulsive disorder are typically no more a threat to others than individuals without these disorders. It is very important to remember that having a mental disorder does not automatically mean that a person is dangerous and most dangerous individuals are not mentally ill.

When it comes to navigating personal relationships, it’s to our advantage to be sensitive to mental health issues. Our mental health as well as the mental health of those we love are crucial to successful interaction. According to the National Institute of Mental Health, around one in four adults in the United States is diagnosable for one or more psychological disorders in a given year.

It’s not easy to determine what is a psychological disorder. The DSM-IV explains, “…the concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations.”

Psychologists define a psychological disorder broadly as psychological dysfunction in an individual that is associated with distress or impairment and a reaction that is not culturally expected. When considering if something is a symptom of a disorder, consider the three Ds: Is it psychologically dysfunctional? Is it distressing or handicapping to the individual or others? Is it associated with a response that is atypical or deviant?

Psychological dysfunction refers to the cessation of purposeful functioning of cognition, emotions or behavior. The comedian Maria Bamford has obsessive-compulsive disorder (OCD), which is expressed in cognitive dysfunction. Any disorder may be expressed in a myriad of ways depending on the person. Bamford has obsessive thoughts about hacking people up and having sex with their body parts. She doesn’t want to have these thoughts. They are involuntary, intrusive and not based in reality. These thoughts distress Bamford.

In some disorders, distress may result directly from emotional dysfunction as in generalized anxiety disorder. Many disorders—eating disorders, personality disorders, mood disorders—entail emotional suffering with their symptoms. However, some people expressing a disorder may not be distressed about it. People with bipolar disorder often enjoy manic episodes, even if these episodes hurt their lives and cause distress for those around them. The distress from a mental illness can come as a byproduct of other problems caused by the mental illness. In this Frontline documentary, you can see how people’s whole lives are wrecked, because they do not have the means to manage mental illnesses.

The last criteria is particularly hard to discern, since what is "normal" is hard to define. Many people have idiosyncrasies or eccentricities that may not be harmful. We shouldn’t assume that because someone acts oddly that their behavior should be harmful. One way to think about whether or not behavior is abnormal is whether or not it is something normal done to the extreme. Bibliomaniacs collect books, which is a normal behavior, but they do it to the point of sabotaging other areas of their lives.

It’s important to note that each one of these conditions is not on its own sufficient to be a disorder. A drunk person can experience psychological dysfunction without having a psychological disorder. Most healthy people have distress over the death of a loved one or even a breakup. Bjork may wear strange outfits and possess a healthy mind.

References

Barlow and Durand (2011). Abnormal Psychology: An Integrated Approach, 6thedition. Belmont, CA;Wadsworth.

What is required for something to be diagnosed as a disorder?

What test is used to identify psychological disorders?