definitions of abnormality

background

DSM 5 (diagnostic and statistics manual of mental disorders) provides clinicians with official definitions and criteria for diagnosing disorders and dysfunctions.

ICD 11 (international classification of disease) is the global standard for recording health info and causes of death, annually updated by world health organisation.

Behavioural symptoms: linked to the way we act

Emotional symptoms: linked to the way we feel

Cognitive symptoms: linked to the way we think, perceive and process information

APD (antisocial personality disorder) can be viewed as abnormal in relation to deviation from social norms. APD means a person is impulsive, aggressive and antisocial. According to DSM 5, a symptom of APD is when individuals show absence of prosocial internal standards, associated with failure to conform to lawful or culturally normative ethical behaviour.

Issues with this: subjective criteria can lead to misdiagnosis and mistreatment, which wastes funds and leads to other medical complications

1. deviation from social norms

A person’s thinking or behaviour is classified as abnormal if it violates the norms of society (unwritten rules about what is expected or acceptable in social groups).

For example: arranged marriages are acceptable in places like India but seen as abnormal in others, queuing is seen as important in Britain but not in other places

Social norms are often reflected in society’s legal system or a country’s rules.

Evaluations:

  • DFSN 5 givens clear definitions of what is and isn’t seen as abnormal (e.g dressing appropriately for a job interview is a norm of society and deviation is abnormal). This is useful as definition is clear cut and not up for interpretation

  • Socially acceptable way to behave in 1 culture may differ in another (culture bound). For example, in some cultures homosexuality is socially unacceptable and are murdered or imprisoned, where as Britain gives them equal rights. This definition, therefore doesn’t give universal account of abnormality because norms differ between places

  • Abnormality is also related to context. For example, it is seen as acceptable for a woman to wear a bikini at the beach but not at a business meeting. Therefore, we cannot generalise norms or classify deviation from these norms as abnormal because they are context dependant and change in different settings

  • This definition is also limited as it is era-dependant. In 1968, homosexuals were classified as sexual deviants; today, gay marriage is legal in the UK and homosexuality is not associated with mental disorders as it had been previously. This definition, therefore, does not reliably define abnormality because there is no consistency over time

failure to function adequately

Behaviour is abnormal if it prevents a person from leading a normal, everyday and functional life; when someone is not able to manage everyday things (like work or school, going shopping and self-care ect.)

Greater number of things you can’t do equals a greater level of abnormality. Clinician uses Global Assessment of Functioning (GAF) scale to asses functioning in various areas of life to indicate need for treatment.

Rosenhan and Seligman identified characteristics to help define failure to function adequately:

  1. Personal distress — symptoms due to suffering the disorder, e.g unhappy and constantly worrying

  2. Maladaptive behaviour — behaviour that prevents you from achieving major life goals, e.g good relationships or career-based

  3. Unpredictable behaviour — behaviour is variable, uncontrolled and inappropriate, e.g losing your temper

  4. Irrational behaviour — others can’t understand why they are choosing to act that way

  5. Observer discomfort — people around feel uncomfortable or stressed by their behaviour

Evaluations:

  • Patients’ perspective is considered, attempts to include the subjective experience of the individual. It is difficult to assess distress but takes into account the experiences of the patient so it is fairly useful a criteria for assessing abnormality

  • May just be deviation from social norms, saying people are failing to function risk limiting personal freedom and discriminating against minority groups (e.g people who do extreme sports or are religious)

  • Checklist definition provides practicality and ease, and makes assessing abnormality more objective

  • Normal abnormality — there are times in people’s lives where it is normal to suffer distress (e.g loved one dying and experiencing psychologically healthy grief) but definition doesn’t consider understandable difficulties like these

  • Subjective nature of features of dysfunction because GAF doesn’t consider behaviour from an individual’s perspective as being normal or abnormal (e.g wearing flamboyant clothes is normal for an eccentric but not someone who is reserved and introverted)

3. deviation from ideal mental health

Someone is considered abnormal when they don’t fit set criteria for good mental health.

Jahoda (humanist) argues there are 6 categories that clinicians refer to when assessing mental health:

  1. Positive attitude towards — self-respect or positive self concept

  2. Self-actualisation — personal growth

  3. Autonomy — self-reliance

  4. Resisting stress — effective coping strategies

  5. Accurate perception of reality — objective or realistic view

  6. Environmental mastery — competence to meet demands of life with flexibility to adapt to changing circumstances

Evaluation:

  • Comprehensive — broad range of criteria

  • Cultural relativism — the criteria are specific to western European and North American cultures. Personal achievement and self-actualisation would be considered self indulgent in collectivist cultures as it emphasises the individual, not the community, so the definition is not representative of all cultures

  • Unrealistic — no one can achieve all criteria at one time or keep up with them for a very long time, therefore everyone would be viewed as abnormal. It can lead to people seeking help for mental health, though

  • Subjective criteria — vague and difficult to measure. Physical health is more objective (as it can be tested with x-rays, blood tests ect.) but mental health relies on self-reports that can be unreliable

4. statistical infrequency

Abnormality is categories as characteristics are less common and statistically rare.

For example, IQ can be displayed on a curve with the normal distribution being the mean scores, those outside of the mean are considered abnormal and this is used to diagnose intellectual disability disorder (IQ below 70, 2% of the population)

Evaluation:

  • Real life applications — useful for diagnosing IDD and can measure severity of mental disorders by comparing statistical norms of symptoms

  • Unusual characteristics can be positive, high IQ would not be perceived as undesirable or needing treatment

  • No benefits from labelling — some people won’t benefit from being labelled as abnormal and may have negative effects on their and others’ view of themselves

  • Stats could be affected by anomalous results — mean will be affected by extreme figures and lead to skewed distribution, leading to less valid and reliable results