How Do You Define A Disorder?


Do you ever feel really bummed? Okay, maybe that’s a silly question because,
like, everyone’s gonna have a crappy day at some point. Right? But how do you know if you’re just feeling sad, or if you’ve crossed over into something
like clinical depression? The answer to that depends on how researchers
define psychological disorders, which isn’t always the clearest thing— especially because these definitions have changed over time as our scientific understanding improves. One main approach to studying disorders is
based on the medical model, which says that a mental disorder is like
a physical illness: it has a specific cause, set of symptoms,
and a best way to treat it. So if a patient comes into a psychiatrist’s
office, for instance, the doctor is going to look at signs and symptoms
to figure out a diagnosis and possible treatments. Signs are the objective, outward indications
that something is wrong. Like if a patient has dry, red, and cracked
skin on their hands, there’s a chance that could be the result
of excessive hand-washing— something patients with obsessive compulsive
disorder might do. On the other hand, symptoms are more subjective
things that are reported by the patient, like if they say they’re feeling sad or
anxious. So professionals like psychologists and psychiatrists, plus policymakers, and health companies,
and the legal system, need to be aware of all of the disorders that
scientists know about. And for that, many turn to the Diagnostic
and Statistical Manual of Mental Disorders, or DSM. It’s a resource that describes known disorders
and how you’d diagnose them. And as of 2013, we’re on the fifth revision
of it, the DSM-5. It’s really hard to standardize and measure
mental health because it’s so complex, but for the most part, all disorders have
a couple major ingredients. First, a patient has to have thoughts, feelings,
or behaviors that are ongoing and unusual. Like, in the DSM-5, major depressive disorder
is defined as experiencing things like sadness, fatigue, loss of appetite, and feelings of worthlessness—all
for at least two weeks. Unusual can also mean things that don’t
necessarily fit into societal norms, which can vary depending on the culture you’re
a part of. And then, this unusual ongoing thing needs
to create distress or impairment. Basically, some people might be sad a lot
of the time, and they’re cool with that. They’re still meeting their responsibilities,
and have social lives that work for them. But other people might feel like there’s
something really wrong—that’s distress. And their symptoms can start messing with
their ability to live their normal lives— that’s impairment. That’s why it’s so important for people
who are experiencing distress to seek help, because psychologists need to understand that
you’re having problems, and you want to fix them. There are other cases where people might not
be feeling distressed by symptoms, but that’s part of the problem. Something like antisocial personality disorder,
for example, may involve aggressive or violent behavior, so there’s a chance you could be a risk to
others. Or schizophrenia can cause false beliefs or
sensations. So psychologists would consider these to be
disorders and try to help treat them. Looking at mental health with the medical
model and the DSM has helped a lot of people, but there are some problems with it too. For one thing, the medical model presumes
that there are clear boxes that signs and symptoms fall into— like a checklist that will lead to a surefire
diagnosis. Problem solved! But that’s not reality. Multiple disorders might share the same causes. Like, if you have a major depressive disorder,
several surveys have found that the chance of having an anxiety disorder too is around 60%. Plus, there might be many different causes
for the same disorder, which could be explained by the diathesis-stress model. The idea here is that some people might have
more biological risk of developing a disorder, but they could live perfectly healthy lives
if they don’t experience psychological influences like stress that can trigger the symptoms. A good example of this is post-traumatic stress
disorder— the anxiety, fear, and panic that people might
suffer after they have a traumatic experience, like abuse or exposure to war. One 2006 study found that war veterans who
developed PTSD had a smaller hippocampus, a brain region that’s associated with memories and emotion, than those who never developed the disorder. It’s not like war shrank part of their brains,
because the study looked at 130 pairs of veterans and their identical non-military twins. And they also had similar-sized hippocampi. So, according to this research and similar
studies, having a smaller hippocampus may be a risk factor for developing PTSD. Another big problem with these systems is
that the DSM is written by humans, and humans make mistakes. Every decade or two the American Psychiatric
Association recruits dozens of psychiatrists, psychologists, neuroscientists and the like to review the
best scientific evidence and decide what changes should be made to reflect our
current understanding of mental illness. But that panel of experts doesn’t always agree,
so there’s flaws and controversy. For example, the definition of major depressive
disorder in the DSM-IV had an exception for people who were grieving the death of a loved one. A patient wouldn’t be diagnosed with depression,
as long as their sadness and other symptoms went away eventually. But in the latest edition of the DSM, that
exception is gone. Some people in the field don’t agree with
this decision, because losing a loved one is sad for anyone! That’s not your brain doing something wrong,
or indicating a depressive disorder. It’s kinda doing exactly what it should be. Others argue that death can be a stressor
that can lead to depression, just like other factors. And people who want to get treatment should
be able to get support for it. The boxes and lines aren’t always clear when
it comes to diagnosing disorders, but plenty of scientists are working on tools
like the DSM and different models of mental health to get
people help when they need it. Thanks for watching this episode of SciShow
Psych, especially if you’re a patron on Patreon! If you’d like to help us make episodes like
this one, you can go to patreon.com/scishow, and for new psychology videos twice a week, head over to youtube.com/scishowpsych and subscribe!

100 thoughts on “How Do You Define A Disorder?

  1. Just a European comment : We use the WHO's "International Classification of Diseases volume 10" or ICD-10. So USA = DSM-5 where Europe and most of the world = ICD-10. There are actually a volume 11 being written right now so soon we can say ICD-11. It would be interesting to make an episode where you compare the ICD-10 to the DSM-5.

  2. I was at a restaurant and the waiter brought the wrong food. I became so angry, "This isn't what I ordered!" That's how I got my disorder 🙁

  3. My aunt had such a hard time when her husband died. They had been married for over 50 years. She asked her doc for help after a few months, but was denied. Her health started to deteriorate, and several of us went to the doc with her the next time to make sure she got help. It's not uncommon for the other partner to die soon after the other one if they've been married a long time and they have a close bond. He should have listened to her in the first place.

  4. How we define disorders is why I struggle to identify the stress that comes from trauma, because I don't have flashbacks. Plus after a while disorders tend to mix together. I no longer know where my anxiety ends and my trauma begins.

  5. I do feel you should have mentioned some of the darker sides of the DSM- categorizing certain behaviors as unhealthy, regardless of patient input, and pathologizing things like homosexuality, the occasionally damaging nature of diagnosis to personal and private lives, etc… but maybe those things would do better in their own video.

  6. I'm betting we see the emergence of computational psychology in the next decade, and computers start doing all the diagnosis work without you even having to seek help.

    We already have computers watching our every move, and we have other computers that are getting really good at diagnosing psychiatric disorders, it isn't a big step to link the two systems. Then you get an email with some instructions on how to manage something you didn't even know you had before it gets bad enough that it significantly affects your life. And also the NSA knows exactly what's knocking around in your head…

    On second thought, let's not.

  7. But why is homosexuality not a disorder while something like dendrophilia is? What's the distinction? I've always wondered about this.

  8. May I ask why do you move your hands when talking and it just something is there a reason some people do and some don't

  9. It would be really helpful if those who make decisions on is DSM didn't receive money from the pharmaceutical industry

  10. There's a shitty guild in WoW named DSM5 after that very book.

    They proclaim to be rather supportive of those with said issues. Don't believe it.

  11. I love when people conflate being transgender with 'gender dysphoria', like they're suddenly some kind of psychology expert, but they completely ignore the fact that many trans people do not meet the requirements for a disorder.

  12. No mention of the belief amongst many medical professions that a disorder is something that can't actually be fixed, only at best ameliorated ? i.e. it's not something that has developed (but perhaps may have been brought to the forefront, perhaps made worse, by circumstances), but was always there in the person.

    My own Avoidant Personality Disorder has been with me as far back as I can remember (around age 2-3 onwards).

    On a side note, to start with I thought Brit's shirt was saying "UFO", but reading the other text (I paused) seems to point to some institute with initials 'UF' ?

  13. 2:09 That's the first time I've ever seen a human being deliberately express this idea

    I'm mildly impressed XD

  14. I'm pretty sure EVERYONE has at least one diagnosable disorder. Most of us simply treat it as part of our identity and never see a psychologist.

  15. You should do a Part II about all the problems that have been caused by using abnormality as a criteria for disorder. I know you already talked about female hysteria, but what about homosexuality, transgenderism, or the recent debate about autism? I say this as someone who thinks ADD should be taken off the next addition of the DSM. Not because I deny that I have a condition. But because I believe the lack of access I was given to alternative schooling constitutes denial of effective treatment. Instead, I was medicated, which messed with my mind and body for the majority of my adolescence, and I am still recovering from the trauma. I think the DSM needs a word for my condition, but given the strong connection between the condition and intelligence and the insufficient evidence that any distress experienced is inherent rather than a reaction to attempting to function within an outdated public school system, "Attention Deficit Disorder" is kind of offensive. And I don't mean personally offensive, although it certainly is that too; I mean offensive just on the level of the kind of arrogance it displays from neurotypical people. How arrogant is it to look at someone who is having trouble concentrating on what you're saying, and conclude that this person's brain must not be functioning properly? What if you're just boring?

  16. What if your disorder is disordered, and doesn't follow standard definitions? Hm? Hmmmmmm?

    Ok, ok.. I just want to be able to say I have 'Disordered disorder disorder".

  17. How do you quantify perspective being that it is entirely subjective? Telling another person they are this or that seems to be reason to put them on medication which is inconsiderate.

  18. hey psych lady, i know most people get mad when they get asked what their tattoo is or what it means,but i just want to know what it is. So someone, help me itch my curiosity, what does her tattoo say!!?

  19. As someone with mdd (major depressive disorder) I think there should be a text of basics to reference. So the doctors know what questions to ask and what to look for. As we all know. We can't remember everything!! If a doc has 100 patients that have stomach problems but 4 or 6 with a mental Illness they might not notice the sign posts along the way of mental illness… but will recognize the basics to get started and refer to the book for further info!!

  20. I love how she wrapped it up with a summary about the disagreement over the late adjustment to the DSM4. It sounded very objective and not offensive, keeping the thought very welcoming for the viewers to try thinking on their own.

  21. Why not cover the fact that the people who wrote this manual all signed confidentiality agreements to not reveal which drug companies they received funding from ? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2802599/
    Or why not talk about how homosexuality was once treated as a mental illness, with one of the treatments for it being shock therapy? I would like to see an episode on the Rosenhan experiment. As somebody who's life was destroyed by this pseudoscience, I think it is important that people know it is purely based on subjective observation, not quantitative scientific research.

  22. The medical model: pathogenesis, symptomatology, and treatment -> Something is wrong with the person and it needs to/should/can be fixed. As has been said here before, this can lead to stigma. I personally find the concept of 'salutogenesis' (cause of health ) to be really interesting.

  23. The Massachusetts high school mock trial case this year was on a murder by a war veteran who was pleading insane under a PTSD-induced hallucination. There were expert witnesses on both sides using the DSM 4. It's pretty interesting to see how these things for into the real world as well. 🙂

  24. a good deal of mental problems are just the brain doing what it should do to address the situation. We get depressed to shut down and make it through a hard time. The problem is that in nature the hard time gets on with itself. In life the hard time needs to be addressed.

  25. how is it that signs and symptoms can be so un-empirical and yet no one questions its authenticity as science, yet if someone gets healed spiritually somehow everyone jumps on how "that's not scientific because there is no empirical evidence."

    I hate science sometimes because of this secular-religious belief system they have and the subsequent denial of any evidence that contradicts it.

    well, I dont hate science. I hate the douche bag skeptic trolls that cling to it like cockroaches.

  26. Why are cuss words a thing? Why is it that in most languages there are words today are considered "dirty" or are generally not socially acceptable

  27. Thank you so much for this video. for years I've been going through something… I don't know what exactly and I'm to afraid to get help because I don't think the label will make things better. sometimes I question my self if what I'm going through is valid and real.

  28. I recently met with a psychiatrist and a new therapist and something that really bothered me was how both of them hadn't even known me for an hour and they were so quick to prescribe me for medications for this, that, and the other thing. I was diagnosed with clinical depression and anxiety disorder but is medication always the best way to go?? I've known plenty of people who were prescribed a medicine and it became the perfect cure but I also know people who DEVELOPED more symptoms after being given meds. I would really like to see a video that talks about the affect medications can have on the body and mind. Are medications the be all and end all to most disabilities or is it more dependent on the person? Can certain medications really affect you in such a way that your symptoms worsen or is it a "its all in your head" thing?

  29. The DSM seems arbitrary to me. For example, homosexuality first appeared as a "sociopathic personality disturbance" in the first edition of DSM in 1953. It was not until 1987 that it was completely dropped from the DSM (although they started the removal process in 1973).

    On the other hand, take the delusional euphoric thoughts we sometimes call religious belief. There is no talk now, nor has there ever been, to include it in the DSM.

  30. my major problem with that view is that it views mental illness as something that can be treated and then its gone and the patient is healthy again. often thats not how it works. many people have to learn to live with their mental health problems and get treatment for some of the symptoms but will never be completly free from it.

  31. As a person who is suffering from Anxiety brought on by Hypochondria, Thank you so much SciShow Psych for doing this episode. 👍👍👍

  32. I would love to see a video describing how we view other cultures around the world. Where we compare these other cultures to ours and if it doesn't fit the exact same thing, they're vilified.

    Such as; The Japanese do not view sex as such a horrific thing as [US]Americans. Yet, if you were to describe the normal sexual behavior of japan to a US citizen, they're likely to say that Japan is barbaric or evil. Even though we use sex in advertisement we still have stigma about people being 'perverts.' When in reality it's just a difference of culture.

  33. If you ask the internet:
    A) Find a medical sounding word on the internet.
    B) Find a thing you do that annoys people.
    C) Blame thing B on thing A.

  34. This really clarifies an issue that came up around something I posted on Reddit about how most mass shootings are committed by people who are sociopathic, not mentally ill with illnesses like schizophrenia, as people often think, much to the detriment of people with schizophrenia. No matter what it is that causes someone to commit an act of evil, I believe there is room for empathy. After all, it's our empathy and compassion that makes us different from them.

  35. I think that is why is important in psychiatry, that we have multiaxial diagnostics:
    1. Clinical problem
    2. Personality disorder
    3. Medical illnesses
    4. Psychosocial problems
    5. Level of function

    Because in that way we can see and understand the patient in a more integrative way.

  36. My room is a disorder. Meaning, a chaos. The, you have the second acceptance. Dis means the opposite of. Disorder is the opposite of order, or the opposite of command

  37. It sounds like they took the grief exception out so they could sell more pills to people. Sad because grandma died? Buy some drugs!

  38. What about someone who thinks that:
    he is Jesus?
    he sees Jesus?
    he hears Jesus?
    Jesus answers his prayers? Sometimes, maybe?
    Jesus had white skin?
    Jesus didn't really kill the fig tree? (Anger issues?)
    Jesus didn't really scold his mother for worrying where he was? (Anger issues?)
    Jesus was born from a virgin and rose from the dead?
    Jesus wasn't the reincarnation of Mithra?
    Jesus died for the sins that Jesus (god) created?
    Jesus is god but he really isn't, but he is?

  39. A life spent surrounded by Medical professionals taught me a LOT!
    It's simple really, you go to a medical professional who (in most cases) barely keeps up with the journals, new discoveries.
    The same 'professionals" that a decade ago barely knew what ADHD was & how it affected children/adults; yet they pretend to be all knowing on the subject.. EVEN back then.
    Even tho it takes decades of research to grasp a mental condition.. Even tho it takes years of study to find out you don't really know all that much about what this drug does..
    And then you prescribe half your patients that drug, because you think it might be fine… probly.
    And you give thousands of kids a drug based on cocaine that (ask any adhd patient) makes you feel horrible over the years & hate the person that drug makes you. It's fucked up.
    Yet you pretend you are an all knowing professional that is flawless. And ask for as much money as a standard dutch Whore would cost you!

    I'd love not to hate the entire industry, but as long as these issues are not dealt with in their studies & serious efforts are made to make sure they never happen again:
    I will respect you less then previously mentioned prostitute.
    And I actually respect the f*ck out of that woman! 😀

  40. This isn't scientific at all. Where is the falsificationism or positivism? This is chalk full of fallacies.
    To claim disorder is to claim order, but where is the foundation for that declarative order?
    And how are claims of symptoms proven, let alone proven to be disorderous or (when it comes to actions or thoughts) ineffective?
    Where is the foundation, metrics, tests, reasoning, double blind experiments, fallacy checking, etc?

  41. Sounds like homosexuality and other sexualities other than straight (being straight is biologically normal) would be classified as disorders, which makes me annoyed that people refuse to recognize them as not a disorder. These sexuality disorders are not bad just because they are disorders, it's just a damn category that they are under in science

  42. the big problem with diagnosis' is that you could have something wrong mentally but not fit enough of the boxes for any existing disorders, and if you don't fit the boxes for a disorder, you can't get help. In other cases, some people are diagnosed with disorders, but only experience some of the symptoms so therefore the standard method of treating that disorder won't be effective (I have a handful of anxiety disorders, but since i don't experience the anxious thoughts, only the anxious feelings, i'm stuck without any options for treatment because CBT focuses on combating anxious thoughts). Treating for symptoms instead of treating for disorders would make a lot more sense.

  43. Hey cool! I like how you used one of Louis Wain's (schizophrenic artist) cat paintings in the background, when mentioning schizophrenia. ^_^

  44. I don't see the problem with using the DSM as a GENERAL outline. Also, being sad for a longer time when a loved one has died is ofc normal, but it can still be useful to get mental support even if it is normal. To properly process get and support when a loved one has died if you want it can be a really useful thing. I don't get why just because it's not something going wrong you can't get support…

  45. Yea… I'm autistic and by the time I ended up searching for an autism diagnosis – from my own research, I had already been diagnosed with 8 different mental illnesses over the course of 5yrs, and psychiatrists regularly disagreed with each other about what I had. Hence me doing my own research. I eventually did get an autism diagnosis a year later. Turns out 5 of those 8 were misdiagnoses. All I have is autism, PTSD, Social Anxiety Disorder, and Major Depressive Disorder (brought on by the PTSD and SAD… like that's actually what's in my diagnostic report. It said to treat the PTSD and SAD, and doing so would make the MDD go away).

    And yet I still had psychiatrists who had thought I had OCD, ADHD, Bipolar Disorder, BPD, and GAD. All because they could tell that I was very abnormal, but they knew nothing about autism, so they just tried to make me fit into their boxes as best that they could. Also that's why I kept having different psychiatrists disagree with each other: because I didn't actually properly fit into any of those boxes, because I didn't actually have those disorders.

    And guess what…. this sort of experience is common. In fact a common phrase in the autism community is: "If your diagnosis list looks like alphabet soup, you're probably autistic."

  46. This is one of the few mainstream critical analyses I've seen of the DSM! Nice job! Would love to see a video about biases of psychiatry as it relates to pharmaceutical companies! And another video about the social/recovery model.

  47. interesting, you consider creating or remembering images as well as creating or remembering sounds/sentences or self talk all in the group of 'thoughts' and feelings (how we move or sensations projected into the body) as feelings, is this a normal distinction in mainstream psych?

  48. I like that you talk about respecting a right for a person to be who they are, if depression is working for them some would inflect their own values on that person

  49. 1) Help them with the tick boxs /not the arbitrary label given to the groupings of ticks!
    -skills development
    -where and when could this 'problem' be helpful (dont take the life saving skill of anxiety away from someone contextualize it)
    -integrate positive intentions and give a sense of understanding (you dont actually need to understand anthers beliefs as long as they do)
    2) decide if its better to tell them what boxs you put them in, or to use the appropriate therapies or skills building without inflicting a label many will incorporate into there identity when it could simply be a set or values/intentions being ignored or displaying those intentions with unhelpful behaviors for example
    3) work with their beliefs, if they believe brains are all science teach them how to change the chemicals by changing the thoughts, if they believe in magic and voodoo show them how to communicate with the gods or past lives which can change the way they feel ect.
    4) if someone isnt getting better before you blame the person you are to incompetent to assist go talk to groups of people that used to have that issue and find out how come about not having it

  50. How to seek help , if u cant even gwt out of the house, have no money , been ripped off or very confused because many doctors tell u different things

Leave a Reply

Your email address will not be published. Required fields are marked *