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Psychological disorders include a wide range of behaviors and mental processes that significantly impact an individual’s functioning and well-being. To determine what constitutes a psychological disorder, psychologists use various approaches that assess the extent to which behaviors or experiences deviate from typical patterns, cause distress, and interfere with daily life.
Factors Used to Identify Psychological Disorders
Psychological disorders are identified by evaluating several key factors, including level of dysfunction, perception of distress, and deviation from social norms.
Level of Dysfunction: This factor assesses the degree to which a behavior or mental process disrupts an individual’s ability to function in important areas of life, such as work, relationships, or self-care. For example, a person with severe anxiety may struggle to maintain employment or attend social gatherings, due to overwhelming fear or avoidance behaviors.
Perception of Distress: Distress refers to the emotional pain or discomfort experienced by the individual. Many psychological disorders, such as depression or obsessive-compulsive disorder (OCD), are characterized by significant feelings of distress that motivate individuals to seek help. However, it’s important to note that not all disorders involve distress; for example, someone with a personality disorder may not perceive a behavior as problematic, even if it causes issues for others.
Deviation from Social Norms: Behaviors or thoughts that deviate significantly from societal expectations may also be considered indicative of a psychological disorder. For instance, cultural norms generally dictate acceptable behaviors, and extreme deviations – such as delusions or hallucinations in psychosis – may signal the presence of a disorder. However, cultural differences must be considered, as what is deemed abnormal in one culture may be acceptable in another.
It is important to know that these factors alone do not constitute a diagnosis but rather provide a foundational framework to be used alongside diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The Medical Model
The medical model is the practice of viewing psychological disorders as diseases. Many terms used to discuss psychological disorders come from the medical model. Diagnosis refers to the process of distinguishing among disorders. Etiology refers to the cause or origin of a disorder. Prognosis refers to a prediction about the probable course and outcome of a disorder.
Diagnosing Psychological Disorders
Diagnosing or classifying psychological disorders has both positive and negative consequences, influenced by factors such as the nature of the disorder, the individual’s personal circumstances, and cultural or societal norms. While diagnosis is essential for effective treatment and understanding, it can also lead to stigma and discrimination, particularly in the presence of societal biases like racism, sexism, ageism, and other forms of prejudice.
Positive Outcomes of Diagnosis
Here are some of the positive outcomes of diagnosing or classifying psychological disorders:
Access to Treatment: A diagnosis provides clarity and enables individuals to receive appropriate interventions, such as therapy or medication. For example, diagnosing major depressive disorders allows healthcare professionals to create targeted treatment plans to address symptoms.
Validation and Understanding: For many individuals, receiving a diagnosis can provide relief by offering an explanation for their struggles. It can help them understand their experiences and reassure them that they are not alone or at fault.
Facilitating Research: Classification systems, such as the DSM, enable researchers to study psychological disorders systematically. This contributes to better treatments, prevention strategies, and awareness of mental health.
Improved Communication: Diagnosis creates a common language among professionals, patients, and families, making it easier to discuss symptoms, treatment options, and progress.
Negative Outcomes of Diagnosis
Here are some of the negative outcomes of diagnosing or classifying psychological disorders:
Stigma and Stereotyping: Diagnoses can carry social stigma, leading others to view individuals as “different” or “less capable.” For instance, someone diagnosed with schizophrenia may face stereotypes about being dangerous or unreliable, even if the condition is being managed effectively.
Discrimination: Societal biases such as racism, sexism, or ageism can influence diagnoses and treatment. For example, studies have shown that Black individuals are more likely to be misdiagnosed with psychotic disorders and less likely to be diagnosed with mood disorders, due to implicit biases in mental health systems. Similarly, psychological symptoms in women are sometimes incorrectly dismissed as hormonal or emotional in origin.
Cultural Bias: Cultural norms shape the definition of “normal” behavior, and diagnostic systems may not account for cultural variations. Behaviors considered abnormal in one culture might be typical in another, leading to misdiagnosis or pathologization of cultural practices.
Self-Perception and Labeling: Receiving a diagnosis can sometimes cause individuals to internalize the label, reducing their self-esteem and limiting their beliefs about their potential. For example, being diagnosed with a learning disability might lead individuals to view themselves as incapable of academic success, even if resources are available to support them.
Overdiagnosis or Misdiagnosis: Misclassification can lead to unnecessary treatment, side effects, and emotional distress. Overdiagnosis of conditions like ADHD in children has raised concerns about the potential for medicalizing normal developmental behavior.
Diagnostic Tools
Diagnosing psychological disorders requires specialized training and the use of evidence-based diagnostic tools to ensure accuracy and consistency. Mental health professionals, such as psychologists and psychiatrists, rely on established classification systems to identify and categorize mental health conditions, enabling effective treatment and communication.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
The DSM, developed by the American Psychiatric Association (APA), is the primary classification system used in the United States to diagnose mental disorders. First published in 1952, the DSM, as of 2013, is in its fifth edition (DSM-5, with a 2020 “text revision” update designated DSM-5-TR). This manual provides standardized criteria for diagnosing psychological conditions, including descriptions of symptoms, duration requirements, and exclusion criteria. The DSM-5 organizes disorders into categories such as mood disorders, anxiety disorders, and psychotic disorders, providing a comprehensive framework for clinical practice and research. It includes dimensional approaches to diagnosing certain disorders (diagnosed on a continuum or spectrum rather than using yes-or-no categories) such as autism spectrum disorder, which recognizes a range of symptom severity. It also incorporates severity scales for conditions like depression, allowing clinicians to assess the intensity of symptoms.
Criticisms of the DSM
Although the DSM is used worldwide and considered a very valuable tool for diagnosing psychological disorders, it has been criticized for several reasons:
- Some critics believe it can lead to normal problems of living being turned into “diseases.” For example, a child who displays inattentive and hyperactive behavior normally seen in young children could be diagnosed with attention-deficit/hyperactivity disorder by an overzealous clinician. In earlier versions of the DSM, homosexuality was listed as a disorder.
- Some critics argue that including relatively minor problems such as caffeine-induced sleep disorder in the DSM will cause people to liken these problems to serious disorders such as schizophrenia or bipolar disorder.
- Other critics argue that giving a person a diagnostic label can be harmful because a label can become a self-fulfilling prophecy. A child diagnosed with attention-deficit/hyperactivity disorder may have difficulty overcoming his problems if he or other people accept the diagnosis as the sole aspect of his personality.
- Some critics point out that the DSM makes the process of diagnosing psychological disorders seem scientific when, in fact, diagnosis is highly subjective.
In general, psychologists view the DSM as a valuable tool that, like all tools, has the potential for misuse.
Culture And Psychological Disorders
Most of the major disorders listed in the DSM are found worldwide, although cultural factors often influence the symptoms and course of disorders. Culture-bound disorders, on the other hand, are limited to specific cultural contexts. They may or may not be linked to DSM diagnostic categories. One example of a culture-bound syndrome described in the DSM is dhat, a condition that occurs in India and is characterized by anxiety, hypochondria, discharge of semen, whitish urine color, weakness, and exhaustion. Similar conditions exist in Sri Lanka and China.
The International Classification of Diseases (ICD)
The ICD, developed by the World Health Organization (WHO), is used internationally and includes diagnoses for both physical and mental health conditions, making it a broader tool than the DSM. The ICD-11, the latest version, provides codes for every disorder, which are widely used for diagnostic, billing, and research purposes. It categorizes mental health disorders under a specific section, similar to the DSM-5.
Both the DSM and the ICD are updated periodically to reflect advances in research and clinical practice. For instance, the DSM-5 introduced changes such as combining subtypes of autism into autism spectrum disorder and redefining trauma-related disorders like post-traumatic stress disorder (PTSD). Similarly, the ICD-11, released in 2019, includes updated classifications for mental health conditions, such as recognizing gaming disorder as a behavioral addiction. These updates ensure that diagnostic criteria remain scientifically valid and clinically relevant.
The use of these tools helps standardize the diagnostic process, improving reliability and validity across practitioners and settings. However, specialized training is essential to apply these systems effectively, as misdiagnosis or overdiagnosis can lead to inappropriate treatment or stigma.
An Eclectic Approach
Most psychologists use an eclectic approach when diagnosing and treating clients, meaning that they draw on multiple psychological perspectives rather than adhering to a single theoretical framework. This approach allows for a more flexible, tailored strategy to address the unique needs of each individual. By combining methods and concepts from various perspectives, psychologists can create a comprehensive treatment plan that accounts for biological, psychological and social factors.
Psychological disorders are complex and often involve overlapping symptoms and causes, making a single perspective insufficient for many cases. For example, depression might stem from biological influences, such as serotonin imbalances as well as cognitive distortions, like persistent negative thoughts and social stressors, such as interpersonal conflict. An eclectic approach allows psychologists to draw from different perspectives to address these interconnected factors. For instance, the biological perspective might inform an understanding of brain chemistry, while the cognitive perspective focuses on thought patterns, and the humanistic perspective emphasizes personal growth and self-actualization.
The Behavioral Perspective
The behavioral perspective explains mental disorders as the result of maladaptive, learned associations between or among responses to stimuli. This approach focuses on observable behaviors and emphasizes how these behaviors are influenced by the environment through processes such as classical conditioning, operant conditioning, and observational learning. Unlike perspectives that explore unconscious or biological causes, the behavioral perspective attributes mental disorders to learned patterns of behavior that can be modified.
Operant conditioning contributes to mental disorders by reinforcing maladaptive behaviors. For instance, a person with social anxiety might avoid social interactions to reduce feelings of discomfort. This avoidance behavior is negatively reinforced because it eliminates the anxiety in the short term, but it perpetuates the disorder by preventing exposure and adaptation.
Observational learning, or modeling, also plays a role. An individual might develop maladaptive behaviors by observing others. For example, a child might mimic a parent’s fear of spiders, internalizing that response as a learned behavior.
The behavioral perspective is particularly influential in developing treatments for mental disorders. Techniques such as exposure therapy and behavioral modification directly target maladaptive behaviors and associations. For example, systematic desensitization gradually exposes individuals to feared stimuli in a controlled manner, helping them unlearn conditioned fear responses.
The Psychodynamic Perspective
The psychodynamic perspective, originating in the work of Sigmund Freud, proposes that the causes of mental disorders stem from unconscious thoughts, conflicts, and experiences, many of which originate during childhood. This perspective emphasizes the role of the unconscious mind, including repressed memories, unresolved conflicts, and early relationships, in shaping behavior and mental health.
According to this view, mental disorders arise when unconscious conflicts, particularly those involving desires, fears, or impulses, remain unresolved. Freud theorized that the mind is divided into three components: the id (primitive desires), the ego (rational decision-making), and the superego (conscience). Mental disorders may occur when these components are in conflict. For example, excessive guilt originating in the superego may clash with forbidden desires from the id, leading to symptoms such as anxiety or depression.
Childhood experiences play a central role in the psychodynamic perspective. Freud believed that unresolved issues arising during early psychosexual stages of development could result in fixation or regression, contributing to psychological problems in adulthood. For instance, children who experience neglect or trauma may develop defense mechanisms – such as repression or denial – that help them cope in the short term but lead to maladaptive behaviors or emotional distress later in life.
In modern psychodynamic approaches, the focus on childhood has expanded to include the influence of early attachments and relationships. Patterns of interaction with caregivers are believed to shape expectations and behaviors in adult relationships. For example, insecure attachment in childhood might contribute to relationship difficulties or trust issues in adulthood.
Therapeutic approaches based on the psychodynamic perspective, such as psychoanalysis or psychodynamic therapy, aim to bring unconscious conflicts into awareness. Techniques like free association, dream analysis, and exploring transference help clients uncover and resolve underlying issues.
The Humanistic Perspective
The humanistic perspective explains mental disorders as resulting from a lack of social support and the inability to fulfill one’s potential for personal growth and self-actualization. This perspective emphasizes the importance of an individual’s subjective experiences and the innate drive toward growth, meaning, and self-improvement.
According to this perspective, mental disorders can arise when basic psychological needs such as love, acceptance, and belonging are not met. For example, Carl Rogers’s concept of unconditional positive regard suggests that individuals thrive when they feel valued and accepted without judgment. When social support is absent or conditional, individuals may develop low self-esteem, self-doubt, or feelings of worthlessness, leading to emotional distress or disorders like depression or anxiety.
Abraham Maslow’s hierarchy of needs also provides a framework for understanding mental health. Maslow proposed that individuals must satisfy basic needs (e.g., safety, belonging) before progressing to higher levels of self-fulfillment, such as achieving self-actualization – the realization of one’s full potential. A person stuck at lower levels of the hierarchy due to unmet needs, such as financial insecurity or social isolation, may experience frustration, stagnation, or psychological distress.
The humanistic perspective also views mental disorders as stemming from a disconnect between one’s self-concept and real-life experiences. When there is a significant gap between who individuals perceive themselves to be and their actual experiences or potential, they may experience inner conflict, feelings of inadequacy, or a lack of purpose.
Therapies based on the humanistic perspective, such as the client-centered therapy developed by Carl Rogers, aim to address these issues by creating a supportive and nonjudgmental environment. Through empathy, active listening, and unconditional positive regard, therapists help clients build self-esteem, explore their goals, and move toward self-actualization.
The Cognitive Perspective
The cognitive perspective explains mental disorders as resulting from maladaptive thoughts, beliefs, attitudes, or emotions that influence behavior and psychological well-being. This approach emphasizes how distorted or irrational thinking patterns can lead to emotional distress and dysfunctional behavior. Unlike perspectives that focus on unconscious processes or learned behaviors, the cognitive perspective highlights the role of internal thought processes in shaping mental health.
Key figures of the cognitive perspective, such as Aaron Beck and Albert Ellis, identified specific types of maladaptive thinking that can cause or exacerbate mental disorders. For instance, Beck’s work on depression revealed that individuals with depressive symptoms often engage in negative cognitive triads involving pessimistic views about the self, the world, and the future. Similarly, Ellis’s rational emotive behavior therapy (REBT), a form of cognitive therapy that focuses on identifying and changing irrational beliefs, identified irrational beliefs and assumptions – such as “I must be perfect to be valued” – as key contributors to emotional problems.
Examples of maladaptive thoughts include cognitive distortions, negative self-talk, and irrational beliefs:
Cognitive distortions – Irrational or exaggerated thought patterns that contribute to negative emotions and maladaptive behaviors. These automatic ways of thinking often reinforce self-defeating beliefs or attitudes. Common cognitive distortions include:
Overgeneralization: Drawing broad conclusions on a single negative event (e.g., “I failed this test, so I’ll never succeed”).
Catastrophizing: Assuming the worst possible outcome will occur (e.g., “If I make a mistake, I’ll ruin everything”).
Black-and-white thinking: Seeing situations as all good or all bad, with no middle ground.
Personalization: Taking excessive responsibility for negative events (e.g., “It’s my fault my team lost”).
Mind-reading: Assuming you know what others are thinking without evidence (e.g., “They must think I’m stupid”).
Negative self-talk: Internal dialogues that reinforce feelings of unworthiness or failure.
Irrational beliefs: Unreasonable assumptions about how the world or oneself should operate, often leading to frustration or hopelessness.
Therapies based on the cognitive perspective, such as cognitive behavioral therapy (CBT), aim to identify and challenge these maladaptive thought patterns. For example, a therapist might help a client recognize and replace distorted thoughts, such as catastrophizing, with more balanced and realistic interpretations. These interventions are widely used to treat a range of disorders, including depression, anxiety, and post-traumatic stress disorder (PTSD). The cognitive perspective excels at providing actionable, evidence-based tools for treating many disorders and empowering individuals to improve their mental health. However, it has limitations, particularly in addressing biological, emotional, and sociocultural factors.
The Evolutionary Perspective
The evolutionary perspective explains mental disorders as behaviors or mental processes that reduce an individual’s likelihood of survival or reproduction. This perspective focuses on how certain traits, which may have been adaptive for survival in past environments, can become maladaptive in modern contexts, leading to psychological disorders.
From an evolutionary standpoint, many mental processes and behaviors evolved because they enhanced survival or reproductive success. For example, fear and anxiety were likely advantageous because they increased vigilance and helped early humans avoid predators or other dangers. However, when these responses are exaggerated or occur in inappropriate contexts, they can lead to disorders such as generalized anxiety disorder or phobias, which impair functioning rather than increasing chances of survival.
Similarly, according to the evolutionary perspective, traits like social bonding, empathy, and cleanliness evolved to strengthen group cohesion and prevent illness. When these traits become dysregulated, however, they may contribute to conditions like depression or obsessive-compulsive disorder (OCD). For example, social bonding mechanisms that fail or are in some way impaired might lead to feelings of isolation and sadness, contributing to depression. Likewise, while a degree of concern for cleanliness might reduce exposure to pathogens, excessive rituals and compulsions can become maladaptive, interfering with daily life.
The evolutionary perspective also examines how modern environments are incompatible with traits that were once advantageous. For example, the human stress response evolved to deal with physical threats, like predators or wildfires, that come and go quickly. In modern contexts, stressors are often ongoing, such as work deadlines or financial pressures. This response can lead to long-term health problems, including stress-related disorders and cardiovascular issues.
The Sociocultural Perspective
The sociocultural perspective explains mental disorders as being influenced by maladaptive social relationships and cultural dynamics. This perspective emphasizes the role of external factors, such as societal norms, family structures, cultural expectations, and socioeconomic status, in shaping mental health. It highlights how an individual’s environment and social context can contribute to the development, expression, and persistence of psychological disorders.
One key focus of the sociocultural perspective is the impact of social relationships on mental health. For example, research shows that individuals experiencing social isolation, chronic conflict, or lack of support are at a higher risk of developing conditions like depression or anxiety. Dysfunctional family relationships, such as those involving neglect or abuse, can also lead to long-term emotional and psychological issues.
Cultural expectations and societal pressures also play a significant role in shaping mental health. For instance, the pressure to conform to unattainable beauty standards or succeed in competitive environments can contribute to disorders like eating disorders and stress-related illnesses. Additionally, cultural stigmas around mental illness may discourage individuals from seeking help, exacerbating symptoms and delaying treatment.
Socioeconomic factors are another critical component. Poverty, discrimination, and systemic inequality can increase vulnerability to mental health disorders by creating chronic stress through factors such as feelings of powerlessness and limited access to healthcare. For example, individuals facing racial or gender discrimination may experience higher rates of anxiety or depression due to systemic barriers and prejudice.
The sociocultural perspective also acknowledges cultural differences in symptom expression and interpretation. For example, some cultures might express psychological distress through physical symptoms, like headaches or stomachaches, rather than emotional complaints.
Therapies associated with the sociocultural perspective often address systemic and interpersonal factors, such as family dynamics or societal pressures, in addition to individual symptoms. For instance, family therapy or community-based interventions may be used to create a supportive environment for individuals dealing with mental health challenges.
The Biological Perspective
The biological perspective explains mental disorders as being primarily caused by physiological or genetic factors. This approach focuses on the role of the brain, the nervous system, hormones, and genetic predispositions in the development and manifestation of psychological disorders. Unlike perspectives that focus on environmental or social influences, the biological perspective looks at physical processes and biological mechanisms.
Abnormalities in brain structures or brain activity are often linked to mental disorders. For example, overactivity in the amygdala has been associated with anxiety disorders, while reduced activity in the prefrontal cortex may contribute to impulsivity and difficulties regulating emotions, as seen in conditions like ADHD and bipolar disorder. Additionally, imbalances in neurotransmitters play a significant role in many disorders. For instance, low levels of serotonin and norepinephrine are associated with depression. Excessive activity in dopamine pathways is linked to schizophrenia and disruptions in GABA (gamma-aminobutyric acid) function are tied to anxiety disorders.
Genetics also plays a key role in mental disorders. Family and twin studies have demonstrated that many conditions, including schizophrenia, bipolar disorder, and depression, often run in families, indicating a strong genetic component. Certain genes or gene-environment interactions may increase an individual’s vulnerability to specific disorders. Similarly, hormonal imbalances can contribute to mental health issues. Cortisol dysregulation can lead to anxiety disorders, and hormonal shifts during pregnancy or menopause can lead to depression.
The biological perspective informs many effective treatments, including medications such as antidepressants, antipsychotics, and mood stabilizers, which target neurotransmitter imbalances. Other interventions, such as electroconvulsive therapy (ECT) or deep brain stimulation (DBS), address severe or treatment-resistant conditions by directly altering brain activity.
While the biological perspective provides a scientifically-based framework for understanding and treating mental disorders, critics note that it may overlook environmental, social, and psychological factors that also influence mental health.
Interaction Models of Psychological Disorders
Interaction models explain psychological disorders by emphasizing the combination of multiple factors in their development. These models propose that no single cause can fully account for the complexity of mental health conditions. Instead, disorders are caused by the interaction of biological, psychological, and sociocultural influences. By combining various perspectives, interaction models provide a more comprehensive framework for understanding mental health and utilize more integrated approaches to diagnosis and treatment.
The Biopsychosocial Model
The biopsychosocial model is one of the most widely accepted interaction models for understanding psychological disorders. It assumes that any psychological problem arises from a combination of biological, psychological, and sociocultural factors. This model highlights how these domains interact to influence the development, expression, and treatment of mental health conditions.
Biological Factors: These include genetic predispositions, brain chemistry, hormonal imbalances, and physical health conditions. For example, a genetic vulnerability to depression or an imbalance in neurotransmitters like serotonin can increase the likelihood of developing the disorder.
Psychological Factors: These include cognitive patterns, emotional regulation, and personality traits. For instance, maladaptive thought processes, such as negative self-talk or catastrophizing, can exacerbate symptoms of anxiety or depression.
Sociocultural Factors: These include environmental and social influences, such as cultural norms, socioeconomic status, family dynamics, and social support. For example, chronic stress from financial instability or discrimination can trigger or worsen psychological disorders.
The biopsychosocial model emphasizes that these factors do not operate in isolation but interact dynamically. For instance, a person with a genetic predisposition to anxiety (biological) might develop symptoms after experiencing trauma (sociocultural) if he or she lacks effective coping strategies (psychological).
This model has significant implications for treatment, encouraging practitioners to adopt a multidimensional approach. Interventions might include medication to address biological factors, therapy to target psychological processes, and social support programs to mitigate environmental stressors.
The Diathesis-Stress Model
The diathesis-stress model explains the development of psychological disorders as the result of an interaction between genetic vulnerabilities (diathesis) and stressful life experiences (stress). This model emphasizes that neither genetic predisposition nor environmental stressors alone are sufficient to cause a disorder. Instead, both must be present for a psychological condition to develop.
A diathesis refers to an individual’s innate vulnerability to a disorder. This could include genetic predispositions, brain abnormalities, or personality traits that make someone more susceptible to developing a specific condition. For example, a person with a family history of depression may have a higher genetic vulnerability to the disorder.
Stress, in this context, refers to environmental factors or life events that trigger the onset of a disorder. These could include traumatic experiences, such as abuse or loss, or ongoing stressors, such as financial problems or chronic relationship conflicts. While stressors alone might not cause a disorder in someone without a vulnerability, they can activate predispositions in those with a diathesis.
For instance, someone with a genetic predisposition to anxiety might remain asymptomatic until they experience a highly stressful event, such as a major transition or a traumatic accident. Similarly, a person with no genetic predisposition to depression might experience stress but not develop the disorder.
The diathesis-stress model is widely used to explain disorders such as schizophrenia, depression, and post-traumatic stress disorder (PTSD). It highlights the importance of both nature (genetics) and nurture (environment) in mental health, showing how they interact to influence psychological outcomes.
This model has practical implications for prevention and treatment. Interventions may focus on reducing stress through therapy, building coping strategies, or addressing environmental factors, while also managing biological vulnerabilities through medication or lifestyle changes.
