UNIT 5.3 · MENTAL AND PHYSICAL HEALTH
Explaining and Classifying Disorders — AP Psychology Notes
Understand DSM-5-TR, ICD, explanatory models, diagnostic context and stigma without reducing people to labels.
What is a Psychological Disorder?
Reason about a presentation in context
- Presentation
Symptoms, duration, severity and functioning - Context and alternatives
Culture, development, medical conditions, substances and life events - Assessment and formulation
Trained evaluation, criteria, possible influences and support needs
Definition
A psychological disorder (also called mental disorder or mental illness) is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in psychological, biological, or developmental processes.
The Three D's Criteria:
The “three D’s” are teaching prompts for considering unusualness, distress and impairment; they are not a checklist that replaces disorder-specific assessment.
1. Deviant (Atypical)
Differs from social or cultural norms. The behavior is unusual, unexpected, or violates social standards. However, deviance alone doesn't mean disorder — cultural context matters.
2. Distressful
Causes suffering or distress to the individual or others. The person experiences pain, discomfort, or concern about their condition.
3. Dysfunctional (Maladaptive)
Impairs ability to function in daily life. Interferes with work, relationships, self-care, or other important activities.
Important Note:
Not all three D's are always required. Some disorders cause distress but aren't deviant (depression is common). Some are deviant but not distressful (person with antisocial personality disorder may not feel distress). Context and clinical judgment matter.
DSM-5: Diagnostic and Statistical Manual
DSM and ICD: DSM-5-TR is the American Psychiatric Association’s manual. ICD-11 is WHO’s classification of diseases and health conditions, including mental, behavioral and neurodevelopmental disorders. Their categories and coding are not identical; professional assessment also considers history, functioning, culture and alternatives.
Key concepts to understand
DSM classification is widely used in the United States. WHO’s ICD is another major international system; neither is a self-diagnosis quiz.
What is the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification system published by the American Psychiatric Association (APA). It provides criteria for diagnosing mental disorders.
Key Features:
- Edition: DSM-5 was published in 2013; DSM-5-TR, its text revision, was published in 2022, with subsequent updates issued by the publisher.
- Contains: Diagnostic descriptions and criteria, associated features and contextual information; avoid treating a count of disorders as a fixed exam fact.
- Purpose: Standardize diagnosis, ensure reliability, facilitate communication among professionals
- Atheoretical: Describes symptoms without assuming specific causes
- Categories: Organizes diagnostic families; depressive disorders and bipolar and related disorders are separate chapters, rather than a single DSM-5-TR mood-disorders chapter.
- 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
- Diagnosis and coding are used in clinical records and reimbursement; coding rules vary by system and jurisdiction. ICD codes are distinct from a claim that DSM is universally required.
- Regularly revised as knowledge evolves
Strengths and Limitations of DSM-5
Strengths
- Reliability: Standardized criteria increase consistency
- Communication: Common language for professionals
- Research: Facilitates systematic study
- Comprehensive: Covers wide range of disorders
- Evidence-based: Based on research
- Regular updates: Evolves with knowledge
Limitations
- Labels can stigmatize: Creates negative stereotypes
- Categorical approach: Treats disorders as discrete when they may be dimensional
- Cultural bias: Based largely on Western norms
- Comorbidity: Many people meet criteria for multiple disorders
- Medicalization: May pathologize normal variations
- Insurance influence: Financial incentives may affect diagnosis
Models for Understanding Psychological Disorders
Diathesis–stress model
A vulnerability interacts with stress to influence the likelihood of a disorder. Genetic susceptibility is one example; learned patterns and developmental experiences may also matter in broader formulations. Vulnerability is not destiny, and exposure to stress does not guarantee a disorder. Protective factors can alter risk.
Medical Model
The medical model frames psychological disorders as conditions that can be assessed and treated, often emphasizing biological mechanisms. It does not imply every disorder has one known biological cause or a guaranteed cure.
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
Biopsychosocial Model (Preferred Approach)
The biopsychosocial model proposes that psychological disorders result from the interaction of biological, psychological, and social factors. It's a more comprehensive approach than the medical model.
Three Interacting Factors:
Biological Factors
- Genetics and heredity
- Brain structure and chemistry
- Neurotransmitter signaling and other biological processes
- Hormones
- Physical health and illness
Psychological Factors
- Thoughts and beliefs
- Learned behaviors and habits
- Personality traits
- Coping strategies
- Trauma and experiences
- Emotions and stress
Social/Cultural Factors
- Social support or isolation
- Cultural beliefs and norms
- Socioeconomic status
- Family relationships
- Life stressors and events
- Discrimination and prejudice
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
Perspectives on Psychological Disorders
Biological Perspective
Views disorders as rooted in biological processes, especially brain structure, chemistry, and genetics.
Key Factors:
- Biological signaling: Dopamine, serotonin, norepinephrine and GABA systems are studied, alongside genetics, circuits and development. A disorder cannot generally be reduced to one transmitter being too high or too low.
- Genetic predisposition: Hereditary vulnerability to disorders
- Brain findings: Group-level structural or functional differences are reported in some disorders. They overlap across groups and are not, by themselves, individual diagnostic tests.
- Hormonal factors: Thyroid problems, stress hormones
- Treatment: Medication, electroconvulsive therapy (ECT), brain stimulation
Psychological Perspectives
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
Sociocultural Perspective
Views disorders as influenced by cultural and social context.
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
Rosenhan Study: "On Being Sane in Insane Places"
IMPORTANT STUDY
David Rosenhan’s 1973 article reported a pseudopatient study that became influential in debates about diagnosis, institutions and labeling. Evaluate its historical context, deception and evidentiary limitations rather than treating it as a test of present-day diagnostic accuracy.
The Study
What Happened:
- Eight mentally healthy people (pseudopatients) went to psychiatric hospitals
- Complained of hearing voices saying "empty," "hollow," "thud"
- The article described pseudopatients presenting a fabricated symptom; do not equate that presentation with an unbiased diagnostic test or assume every historical detail is independently established.
- 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 interpreted as “writing behavior”)
- Stayed 7-52 days (average 19 days) before being released
- The article reported discharge descriptions such as schizophrenia “in remission”; these reports illustrate the interpretation of labels, not proof that contemporary clinicians cannot assess disorders.
Part 2: The Challenge
In a second reported exercise, 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
- Methodological limit: A deceptive admission scenario and historical report do not estimate the reliability or validity of all diagnoses.
- Stigma: Labels stick and influence treatment
- Context matters: Same behavior viewed differently in mental hospital vs. outside
- Possible expectation effects: Labels may change how people are treated; a self-fulfilling effect requires an intervening behavioral process, not simply having a diagnosis.
- Depersonalization: Patients treated as diagnoses, not people
Labeling and Stigma
The Power of Labels
Labeling is assigning a diagnostic category to a person. While labels help with diagnosis and treatment, they can also have negative consequences.
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
- Expectation effects: A label can influence self-concept or others’ behavior, but does not compel someone to behave according to a stereotype.
- 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
Stigma and Discrimination
Stigma is negative attitudes and beliefs about people with mental illness that lead to stereotyping, prejudice, and discrimination.
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 Considerations in Diagnosis
Culture and Mental Disorders
Culture profoundly influences how mental disorders are expressed, perceived, diagnosed, and treated. What's considered "abnormal" varies across cultures.
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
AP Exam Strategy
Multiple Choice Tips
- Know the Three D's: Deviant (atypical), distressful (causes suffering), dysfunctional (impairs functioning)
- Master DSM-5: What it is (diagnostic manual), purpose (standardize diagnosis), strengths and limitations
- Distinguish models: Medical model (biological illness) vs. biopsychosocial (biological + psychological + social)
- Understand Rosenhan study: Pseudopatients, labeling effects, diagnostic reliability problems
- Know perspectives: Biological (brain, genes), psychological (thoughts, learning), sociocultural (culture, society)
- Recognize labeling effects: Benefits (communication) vs. risks (stigma, self-fulfilling prophecy)
- Consider cultural factors: Culture affects symptoms, diagnosis, treatment
Free Response Question (FRQ) Tips
- Apply Three D's to scenarios: Given behavior, determine if it meets criteria for disorder
- Explain biopsychosocial model: Show how all three factors interact in specific disorder
- Describe Rosenhan study completely: Procedure, results, implications for diagnosis and labeling
- Compare perspectives: How biological vs. psychological vs. sociocultural views explain same disorder
- Discuss labeling consequences: Both positive (treatment guidance) and negative (stigma)
- Address cultural considerations: Explain how culture influences diagnosis and treatment
- Use proper terminology: "DSM-5" not "diagnosis book"
Quick Review Summary
The Big Picture
A disorder involves clinically significant disturbance assessed in context. Distress, impairment and deviation from norms are considerations, not a universal three-item diagnostic checklist. DSM-5-TR and ICD-11 organize classifications; reliability, validity and cultural interpretation are separate issues. Biological, psychological and social perspectives can be integrated, including vulnerability–stress interactions. Rosenhan’s historical report raises questions about labels and institutions without establishing the accuracy of modern diagnosis. Labels can aid communication and access to care while also contributing to stigma.
Essential Concepts
- Psychological disorder
- Three D's (Deviant, Distressful, Dysfunctional)
- DSM-5
- Diagnostic and Statistical Manual
- American Psychiatric Association (APA)
- Medical model
- Biopsychosocial model
- Biological perspective
- Psychological perspectives
- Sociocultural perspective
- Rosenhan study
- David Rosenhan
- Pseudopatients
- Labeling
- Stigma
- Discrimination
- Self-fulfilling prophecy
- Cultural considerations
- Culture-bound syndromes
- Diagnostic bias
Quick FAQs
Are the three D’s a diagnostic checklist?
No. They are prompts for considering distress, dysfunction and norms. Diagnosis requires disorder-specific criteria, context and trained assessment.
Do DSM and ICD mean the same thing?
No. DSM is the American Psychiatric Association’s manual; ICD is WHO’s broader international classification. Both organize disorders, with differences in their systems.