Do You Have Symptoms of a Mental Disorder?

What Are the Symptoms of a Mental Disorder?

In psychology, “symptoms” are indicators of a mental disorder. However, before they are “symptoms,” these terms refer to experiences that we all have.

Identifying experiences as “symptoms” is one way of making sense of what is going on. When you do this, you are using a mental illness frame of reference.

There are many life difficulties or misfortunes that lead to suffering, such as sadness, anguish, grief, heartbreak, irritability, loss of sleep, worry, avoiding people, acting unkindly, etc. The list of reactions and feelings we have regarding our misfortunes is long. The risk of labeling such feelings and reactions to our misfortunes as symptoms of mental illness is increasing. This phenomenon is called pathologizing the human experience.

If you are wondering if you have “symptoms” of a mental illness or disorder, you will want to know:

• How professionals define mental illness
• Imprecision in diagnosing mental illness
• The problem with diagnosing thoughts, feelings, and behaviors
• Whether you have the symptoms and what can be done about them

What Is Mental Illness?

Derek Bolton is a Professor of Philosophy and Psychopathology at Kings College in London who asks the question, “What is mental illness?”¹ He tells us that the fundamental idea of a “mental disorder” as identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association is that it is a significant behavioral or psychological syndrome or pattern that is associated with distress and suffering and/or impairment and dysfunction.

Mental health professionals assess the degree to which you feel distressed and/or show some impairment in functioning in your life to identify an experience as a “symptom” of a mental disorder. The various diagnoses outlined in the DSM-5 have lists of such “symptoms” that go together to form a pattern or syndrome. It is these patterns of symptoms that are considered to have a specific diagnosis.

For Bolton, the DSM-5 conceptualization of mental illness is helpful in diagnosing mental illness but not a sure thing. For him, it is more like a position statement about the following features:

• Mental disorder is essentially linked to distress and impairment.
• It is distinct from normal distress and impairment… somehow.
• It is not to be muddled up with other cultural or subcultural ways of doing things.
• Being in conflict with society, without something else being wrong with the person, has nothing to do with mental illness.

To use imprecise descriptions of our feeling and actions as the sole criteria of mental illness is not good enough. What we really want are “biomarkers” of specific psychiatric diagnoses. While this has been and continues to be achieved in physical illnesses, “…no well replicated, reasonably sensitive and specific biomarkers have been identified for any mental illness”.²

What we do have are a number of risk factors for psychiatric conditions, including:

• Genetic risks
• Pre-natal nutrient and hormonal environments
• Early maternal and child-rearing practices, including abuse and neglect
• Life stressors
• Maladaptive cognitive styles
• Social determinants including social exclusion, poverty, and wealth inequality

The hope is that a complex array of biopsychosocial causes may lead to a single, final common biological pathway for each clinical psychiatric syndrome. Until this happens, we are stuck with imprecise indicators of mental illness. It is this imprecision that contributes to the increasing pathologizing of human experience.

Imprecision in Diagnosing Mental Illness

There are two ways in which problems arise in the diagnosis of mental illness. One is the imprecision in deciding what constitutes a symptom of mental illness. The second is the expanding scope of various psychiatric diagnoses.

Imprecision in Designating Experiences as Symptoms

Psychologist Jeffrey Rubin argues it is not reasonable to describe people who are suffering or distressed as having a “mental disorder.”³ He gives the following examples of people who are suffering but are not mentally ill:

• Writers who receive a rejection from a publisher may be suffering or distressed, but that is not pathological.
• When a loved one dies, we are likely to suffer and be distressed. This is bereavement.

Most of us are likely to experience suffering or distress at some time in our lives. How much suffering beyond what is typical in our lived experiences of disappointments and misfortunes is needed to be classified as pathological?

Expanding Scope of Existing Diagnoses

Psychologist Dan Peters points out that in the DSM-5, some diagnostic categories have been added, and fewer “symptoms” are needed to “meet diagnostic criteria” for some diagnoses.⁴ He cites the following examples of these changes:

• Temper tantrums can be diagnosed as Disruptive Mood Dysregulation Disorder.
• Gluttony can be diagnosed as Binge-Eating Disorder.
• Grief can be diagnosed as Major Depression.
• First-time substance users can get a diagnosis of Substance Use Disorder.
• Everyday worry can be diagnosed as Generalized Anxiety Disorder.

Diagnosable Behaviors Are Getting More Inclusive

Psychologist Nick Haslam, professor of psychology at the University of Melbourne in Australia, notes that negative experiences such as abuse, bullying, and trauma, which are diagnosable, have come to include less extreme and different kinds of experiences. He identifies this phenomenon as "concept creep."

The more experiences we have through such "concept creep" that are said to cause us suffering or distress and/or dysfunction or impairment, the more likely we are to identify or have identified for us those experiences as “symptoms” of a mental disorder requiring diagnosis and treatment.

The Trouble With Diagnosing Thoughts, Feelings, and Behavior

Professionals in the mental health field are increasingly speaking out about the problems with diagnosing our thoughts, feelings, and behaviors. Once diagnosed, the most frequent mode of treatment for psychiatric conditions is medication, even though there are no reliable biological markers of illness. Vague references are often made to biological causes for the illness. For example, patients may be told that their depression is caused by an “imbalance in neurotransmitters.”⁶

These professionals also point out you have to have a “diagnosis” to meet “medical necessity” to receive services. This means if you approach a professional for help, you have to have a diagnosis, or you don’t get services. Another impediment to receiving services is that what is “medical necessity” is monitored by the insurance provider, which has a profit motive to deny services.

What Can We Do?

There are some professionals who are opting for alternatives to the mental illness labeling process. Psychologists Jeffrey Rubin and Peter Kinderman have developed systems based on mental health concerns and personal well-being.^7,8 Both want helping professionals to “drop the language of disorder,” which pathologizes human experience as dysfunctions of the brain. Kinderman points out that this creates the idea for people that the “problem” is within them. He points to a study he did of 4,600 people recently diagnosed with a mental disorder in which less than 1 percent of the cases noted socioeconomic or psychosocial factors—unemployment, childhood trauma, work-related trouble—that could have contributed to the problem.

Lucy Johnstone, a British clinical psychologist, promotes “psychological formulation” as an alternative to diagnosis.⁹ A formulation is a hypothesis that addresses the client’s concerns about their experiences in conjunction with the best evidence about such experiences the professional brings. The formulation is tailored to the particular client’s concerns about what they are experiencing: for example, mood swings or feeling suicidal or self-injuring. Once arriving at this formulation, a competing hypothesis that says, “And it is also because you have bipolar disorder/clinical depression/borderline personality,” is redundant.

Johnstone and her colleagues have written extensively about this psychological formulation approach offered as an alternative to more traditional models of mental health based on psychiatric diagnosis. This framework creates more hopeful views of clients’ lives and their difficulties instead of seeing them as “mentally ill.”

So, Are Your Feelings, Thoughts, and Behaviors “Symptoms” of a Mental Illness?

As a society, we are becoming more accepting of mental illness—and this is a good thing. At the same time, the range of emotions we experience is increasingly likely to be seen by us as possible “symptoms” of some mental disturbance that leads us to seek professional help. We adopt the “mental illness” framework to explain our uncomfortable and worrisome experiences.

There is a new line of psychological research that suggests that getting through such difficult or negative experiences, such as death, divorce, health crisis, or loss of a job, can add meaning to your life. This new approach to making sense of our difficult life experiences is discussed in my next post.