Unit 5.3: Explaining and Classifying Psychological Disorders

The Three D's Criteria:

To be considered a psychological disorder, a pattern of behavior typically must meet these criteria:

Key Features:

• Current version: DSM-5 (published 2013; DSM-5-TR text revision 2022)
• Contains: Descriptions, symptoms, and diagnostic criteria for over 300 disorders
• Purpose: Standardize diagnosis, ensure reliability, facilitate communication among professionals
• Atheoretical: Describes symptoms without assuming specific causes
• Categories: Organizes disorders into groups (mood disorders, anxiety disorders, etc.)
• Cultural considerations: Includes cultural variations in symptoms

How It's Used:

• Clinicians use specific criteria to diagnose disorders
• Provides common language for professionals
• Used for research to study specific disorders
• Required for insurance billing and reimbursement
• Regularly revised as knowledge evolves

Key Assumptions:

• Disorders are illnesses with biological/genetic causes
• Can be diagnosed based on symptoms
• Treated with medical interventions (medication, procedures)
• Focus on identifying and treating pathology
• Uses medical terminology (patient, symptoms, treatment, cure)

Advantages:

• Reduces stigma (it's an illness, not a character flaw)
• Emphasizes need for professional treatment
• Facilitates research into biological causes
• Led to effective biological treatments

Criticisms:

• Oversimplifies complex disorders (ignores psychological and social factors)
• Can promote passive patient role ("fix me with pills")
• May pathologize normal human experiences
• Doesn't explain all disorders adequately
• Labels can still stigmatize despite good intentions

Three Interacting Factors:

Advantages:

• Comprehensive and holistic
• Explains why disorders affect people differently
• Accounts for multiple causes and treatments
• Integrates biological, psychological, and social perspectives
• Currently most accepted model in psychology

Key Factors:

• Neurotransmitter imbalances: Too much/little dopamine, serotonin, norepinephrine, GABA
• Genetic predisposition: Hereditary vulnerability to disorders
• Brain structure abnormalities: Enlarged ventricles in schizophrenia, smaller hippocampus in depression
• Hormonal factors: Thyroid problems, stress hormones
• Treatment: Medication, electroconvulsive therapy (ECT), brain stimulation

Psychodynamic (Freud)

• Disorders result from unconscious conflicts
• Unresolved childhood experiences
• Defense mechanisms used maladaptively
• Treatment: Psychoanalysis, exploring unconscious

Behavioral

• Disorders are learned maladaptive behaviors
• Classical and operant conditioning create problems
• Observational learning of dysfunctional patterns
• Treatment: Change behaviors through conditioning, reinforcement

Cognitive

• Disorders result from distorted thinking patterns
• Negative automatic thoughts
• Irrational beliefs and cognitive errors
• Treatment: Cognitive therapy, challenge and change thoughts

Key Factors:

• Cultural norms: What's "abnormal" varies by culture
• Social stressors: Poverty, discrimination, violence
• Social support: Isolation vs. community
• Cultural expressions: Symptoms manifest differently across cultures
• Societal expectations: Gender roles, family structure
• Treatment: Consider cultural context, family therapy, community interventions

What Happened:

• Eight mentally healthy people (pseudopatients) went to psychiatric hospitals
• Complained of hearing voices saying "empty," "hollow," "thud"
• Otherwise acted normally and gave accurate personal histories
• All were admitted to hospitals (diagnosed mostly with schizophrenia)
• Once inside, acted completely normal and said they felt fine
• Took notes about their experience
• Staff interpreted normal behaviors as symptoms (note-taking = "writing behavior")
• Stayed 7-52 days (average 19 days) before being released
• Released with diagnosis "schizophrenia in remission" (not "you were never sick")

Part 2: The Challenge

After publication, a hospital challenged Rosenhan, claiming they could detect pseudopatients. Rosenhan said he would send pseudopatients over three months.

• Hospital staff rated 193 patients on likelihood of being pseudopatients
• 41 patients judged highly likely to be fake by at least one staff member
• 23 patients identified as pseudopatients by at least one psychiatrist
• The twist: Rosenhan sent NO pseudopatients at all!

Conclusions and Implications:

• Labeling effects: Once labeled "mentally ill," all behavior interpreted through that lens
• Diagnostic unreliability: Couldn't distinguish sane from insane
• Stigma: Labels stick and influence treatment
• Context matters: Same behavior viewed differently in mental hospital vs. outside
• Self-fulfilling prophecy: Labels create expectations that shape behavior
• Depersonalization: Patients treated as diagnoses, not people

Benefits of Labels:

• Facilitate communication among professionals
• Guide treatment decisions
• Help people understand their experiences
• Enable research on specific disorders
• May reduce blame (it's an illness, not personal failure)

Risks of Labels:

• Stigma: Negative stereotypes and discrimination
• Self-fulfilling prophecy: Person behaves according to label
• Overgeneralization: Person reduced to their diagnosis
• Loss of identity: Seen as "schizophrenic" not "person with schizophrenia"
• Changed expectations: Others treat person differently
• Confirmation bias: All behaviors seen through lens of disorder

Consequences of Stigma:

• People avoid seeking treatment (fear of being labeled)
• Social isolation and loneliness
• Employment and housing discrimination
• Reduced self-esteem and self-efficacy
• Worse treatment outcomes
• Stereotypes portrayed in media (dangerous, unpredictable)
• Reality: People with mental illness are more likely to be victims than perpetrators of violence

Cultural Influences:

• Symptom expression: How disorders manifest differs (somatic vs. psychological symptoms)
• Beliefs about causes: Spiritual, supernatural, biological explanations
• Acceptable behaviors: What's deviant in one culture is normal in another
• Help-seeking patterns: Medical doctor, traditional healer, religious leader, family
• Treatment preferences: Medication, talk therapy, spiritual practices, community rituals

Culture-Bound Syndromes:

Patterns of symptoms that appear primarily in specific cultural contexts. Examples:

• Taijin kyofusho (Japan): Fear of offending others with one's body or appearance
• Ataque de nervios (Latin America): Intense emotional distress with crying, trembling, fainting
• Koro (Southeast Asia): Intense fear that genitals are retracting into body

Avoiding Diagnostic Bias:

• Consider cultural context when diagnosing
• Be aware of clinician's own cultural assumptions
• Use culturally sensitive assessment tools
• Understand that DSM-5 is based largely on Western norms
• Consult with cultural experts when needed