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What is a Psychological Disorder?

Vanessa Tate

Vassar College
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Abstract

This paper attempts to establish a definition of a psychological disorder by considering all of the

components that make up any identifiable diagnosis. It addresses many of the theories and

perspectives in the field of psychiatry and how they can affect our philosophical understanding

of what a psychological disorder is. Because there is no singular definition, to distinguish

disorders from non-disordered states, there are several key principles that can be applied when

considering diagnoses of signs and symptoms. These principles are largely based on criteria

presented in several diagnostic systems, and are applicable in a range of contexts, from clinical

assessment to research.
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What is a Psychological Disorder?

A psychological disorder consists a set of coexisting signs and symptoms, outside of

conventional human behavior, that causes significant distress in multiple areas of a persons life.

The first component of this definition refers to the signs and symptoms associated with a

disorder. Symptoms refer to phenomena experienced and reported by the patient affected by the

disorder, while signs can be observed by other individuals. While a single sign or symptom on its

own may not say much about a persons condition, it can be used as diagnostic criteria when

present alongside others. Although several different diagnostic systems exist including the

Diagnostic and Statistical Manual of Mental Disorders (DSM) and Research Domain Criteria

(RDoC), they are united in that they are heavily based on specific patterns of signs and

symptoms. While they vastly differ in their specific criteria, both stress the importance of

behaviors and physiological dysfunctions as a way of gaining insight to a persons condition.

According to DSM-5, the signs and symptoms observed in a psychiatric patient can cause

significant disturbance in cognition, emotion regulation, or behavior (American Psychiatric

Association, 2013).

The next component of a psychological disorder clarifies that whatever behaviors are

observed cannot be related to conventional, expected behavior of a typical person in a society.

While it is impossible to give a single definition of conventional human behavior, this refers to

the fact that many external factors can give rise to symptoms that resemble, but are unrelated to

actual mental disorders. DSM-5 lists one such factor as the death of a loved one, which would

naturally lead to some form of a grieving process, an expectable or culturally approved

response (American Psychiatric Association, 2013).

The concept of significant distress can vary from person to person and across different

disorders, but is a uniting factor among all psychological disorders. According to psychiatrist

Kenneth Kendler, there are more reasons to defend the realist of broad classes of psychiatric

illness than the controversial criteria of any specific categories (Kendler, 2016). This is because

the distress caused by certain psychological disorders is significant enough to at least agree upon

the larger picture of what clinicians, researchers, and even patients themselves may observe. The

distress caused by a mental disorder may affect several aspects of a persons life including social,

occupation, and other important activities (American Psychiatric Association, 2013). While the

field of psychiatry is built on various theories, many of which conflict with each other, this is a

definition that addresses many of the key points that most perspectives seem to agree upon.

According to Jerome Wakefield, a definition and general understanding of a mental disorder is

critical to many of the varied positions of other figures in psychiatry (Phillips et al., 2012).

In the history of psychiatry, many philosophical perspectives have emerged in regards to

understanding psychological conditions. In order to assign a name to a psychological condition

and use it to distinguish patterns of behavior, there must be a general idea of what type of thing a

disorder is. The source of psychological conditions seems to be one of the most disputed issues.

One of the most prevalent theories is realism, which assumes that the science of psychiatry is

based on factual truth (Kendler, 2016). Heavily grounded in concepts of biological

classification, this position focused on the idea, psychiatrists with a realist perspective believe

that disorders exist in nature, independent of our efforts to classify them. Per the definition in

DSM-5, the disturbances in an individuals behavior based on a psychological, biological, or

developmental dysfunction (American Psychiatric Association, 2013). From a realist perspective,

these dysfunctions form the basis of the already existing conditions that we merely discover.
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Constructivism is a theory that contradicts the factual basis of the realism. The constructivist

nature of psychiatric disorders paints them as a social construct, created by researchers and

clinicians as a method of social control against individuals who dont fit in (Kendler, 2016). This

theory is supported by diagnoses skewed by social and cultural biases, but underemphasizes

specific patterns of biology and behavior observed by realists. Pragmatism is a third perspective

in psychiatry, which differs from realism and pragmatism in the focus of approaching disorders.

Rather than make a clear statement on the origins of a psychological disorder or focus on

underlying processes, pragmatism focuses on finding a diagnosis that can inform a clinician the

prognosis of the disease and what treatment should be used (Kendler, 2016). In other words,

from this viewpoint, the most important aspect of a diagnosis is how useful it is in a clinical

setting. There are several additional approaches, outlined by the metaphorical umpires of

epistemology, who exist as a simplified representation of various psychological perspectives

(Phillips et al., 2012). The original creator of these epistemological umpires, Allen Frances, was

partial to a nominalist approach, but successfully conveyed the ideas theorized by many others in

the field of psychiatry.

Differences in the approach to understanding psychological disorders not only leads to

the development of contrasting theories but also plays a role in the differences between systems

such as DSM and RDoC. DSM is a standard diagnostic system used for both scientific and

practical purposes. First published in 1952, this manual has faced many criticisms on its

framework, validity, and general categorization of disorders, and has been significantly modified

and expanded since its first edition (Kendler, 2013). When considering DSM categories

historically, many of the diagnostic criteria were based on very precise definitions, taking a more

categorical approach. While DSM does contain some dimensional components, RDoC is
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explicitly dimensional and avoids creating DSM-like categories (Cuthbert & Insel, 2013). RDoC

is an integrative approach, emphasizing the importance of both behavioral and neurophysical

components of disorders. This design is based on a body of research that describes an

alternative phenotypic dimensional structure of psychopathology (Krueger & DeYoung, 2016,

pp. 351). These two systems of diagnosing mental disorders reflect different ways of

approaching mental disorders, which will continue to be altered as increasingly advanced

research continues to shed light on topics in the field of psychiatry.

When considering psychological disorders, one of the most significant components is

proper assessment and diagnosis. For a patient to receive proper treatment, it must first be

determined whether or not a disorder is present. This raises the question of how to distinguish

between psychological disorders and non-disordered states. The identification diagnosis of such

a disorder is important not only for individual clinical treatment, but in the contexts of education,

law, and scientific research.

The first key principle in identifying a psychological disorder is that an individual must

fit certain criteria in terms of their behavior and cognition. In defining a mental disorder as a

syndrome, DSM-V acknowledges that such disorders are based on specific collections of

symptoms presented simultaneously (American Psychiatric Association, 2013). Categorizations

of these signs and symptoms are critical in the design of the semi-structured interview portion of

clinical assessments. This idea of diagnosing by conformation to criteria is also part of the

motivation behind standardizing assessments, such as stimulus attribution tests. These tests are

based on responses to open-ended questions, such as having an individual complete a sentence or

create a story based on an image. Because these types of tasks can lead to a large variety of

answers, there is an even larger variety of interpretations. Standardizing these tests allows for
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results to be used as a more appropriate judge of personality measures used in other diagnostic

assessments and also as a consistent comparison to responses typical of individuals without an

emotional or thought disorder.

Another key principle is based on the context of signs and symptoms. There are many

external stressors that can lead to the expression of behavior that resembles signs or symptoms of

disorders. For example, while emotional responses can often give insight into a disorder, it is

important to acknowledge that not all such responses are related to a disorder. When an

individual presents symptoms of depression, it is important to know if these symptoms emerged

after a recent loss or another traumatic incident. There is no set definition of how long after such

an incident that symptoms should last before labeling it a disorder, but this is an important

consideration whenever a diagnosis is being made. If a response to a stimulus is considered to be

expected or socially acceptable, then it is possible that a disorder is not the cause of exhibited

behavior. Determining context is critical in ensuring validity and should be confirmed in several

steps in the process of assessment.

When considering the second key principle, it is important to note that not all

unexpected behavior can be attributed to a disorder. There has been a history of misattributing

socially deviant behavior to an underlying psychological disorder. DSM-5 specifically states in

the definition of a mental disorder that any observed behavior that fits diagnostic must result

from a specific dysfunction of the body (American Psychiatric Association, 2013). One class of

behavior that has been victim to a false diagnosis is homosexuality. Homosexual behavior,

considered a crime against nature for centuries, was eventually excused as the result of a

mental illness in the late 19th century (Levin, 2016). Although it is now understood that same-sex

behavior is tied to sexual orientation and absent from modern editions of DSM, it demonstrates
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how the line between disorder and non-disorder has had a troubling history in regards to

behavior that is not widely accepted in society. Considering this alteration of the definition of

mental illness over time, an additional key principle would be the recognition of alternative

motivations for certain behaviors unrelated to biological or psychological dysfunction. This is

particularly relevant when cultural and social biases play a role in the diagnostic process. A

persons identity, whether it be sexual, religious, ethnic, or political, can also play a role in the

assessment of behavior in modern psychological assessments (Bornstein, 2016). When the

identity of the patient and assessor differ, priming of certain identity-related attitudes, thoughts,

and feelings may challenge the validity of the testing and assessment process, thus complicating

the process of diagnosing patterns of behavior as a psychological disorder aside from the basis of

dysfunction.

Another key principle for identifying psychological disorders is considering a biological

or genetic component. Although DSM and RDoC take a different approach in the direction, both

diagnostic systems look at phenotypes and genotypes in relation to a disorder. A genome-wide

association study showed that single nucleotide polymorphisms(SNPs) can contribute to the risk

of a variety of mental disorders, including schizophrenia and ADHD, with high correlations of

SNPs between disorders (Lilenfeld & Treadway, 2016). However, genetic observations are not

always a clear indicator. Endophenotypes are state-independent phenotypes with a significant

genetic connection. These often serve as construct-valid indicators of psychobiological system

that are influenced by genes. Endophenotypes are heritable and are also found within families of

an affected patient. The presence of a gene or biological marker does not necessarily indicate that

a person has a disorder. Despite researched correlations between mental state and genes, genetic

components cannot be used independently for diagnostic purposes. This does not mean,
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however, that genetics should be ignore entirely. Looking beyond genetics, there may be other

biological indications when a disorder is present. Results from early forms of assessment may

lead to neurocognitive assessment, which in turn may warrant further neuroimaging to look for

neurological signs of a disease. Other psychophysiological tests, such as EEGs, provide

information about an individuals brain function and its relation to their psychological condition.

To successfully distinguish afflicted from non-afflicted individuals, genetics and biology are

additional factors besides surface-level analysis of behavior that should be taken into account.

Overall, there are many perspectives of defining, diagnosing, and assessing psychological

conditions. Theories have been formulated through the ages to try and make sense of behaviors

we observe and experience that do not line up with societal expectations. While there are

certainly flaws in the system, the field of psychiatry has come a long way in terms of addressing

domains and criteria as they relate to our mental fitness. The ability to create a collaborative

definition and understanding of a mental disorder spanning all psychiatric perspectives will allow

clinicians and researchers to apply a standardized knowledge to the various contexts in which

mental health is relevant. Future research will allow us to gain further insight into psychological

conditions and allow for more effective diagnosis and treatment.

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