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32.5: The American Psychiatric Association (APA) Definition

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    77076
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    Many of the features of the harmful dysfunction model are incorporated in a formal definition of psychological disorder developed by the American Psychiatric Association (APA). According to the APA (2013), a psychological disorder is a condition that is said to consist of the following:

    • There are significant disturbances in thoughts, feelings, and behaviors. A person must experience inner states (e.g., thoughts and/or feelings) and exhibit behaviors that are clearly disturbed—that is, unusual, but in a negative, self-defeating way. Often, such disturbances are troubling to those around the individual who experiences them. For example, an individual who is uncontrollably preoccupied by thoughts of germs spends hours each day bathing, has inner experiences, and displays behaviors that most would consider atypical and negative (disturbed) and that would likely be troubling to family members.
    • The disturbances reflect some kind of biological, psychological, or developmental dysfunction. Disturbed patterns of inner experiences and behaviors should reflect some flaw (dysfunction) in the internal biological, psychological, and developmental mechanisms that lead to normal, healthy psychological functioning. For example, the hallucinations observed in schizophrenia could be a sign of brain abnormalities.
    • The disturbances lead to significant distress or disability in one’s life. A person’s inner experiences and behaviors are considered to reflect a psychological disorder if they cause the person considerable distress or greatly impair his ability to function as a normal individual (often referred to as functional impairment, or occupational and social impairment). As an illustration, a person’s fear of social situations might be so distressing that it causes the person to avoid all social situations (e.g., preventing that person from being able to attend class or apply for a job).
    • The disturbances do not reflect expected or culturally approved responses to certain events. Disturbances in thoughts, feelings, and behaviors must be socially unacceptable responses to certain events that often happen in life. For example, it is perfectly natural (and expected) that a person would experience great sadness and might wish to be left alone following the death of a close family member. Because such reactions are in some ways culturally expected, the individual would not be assumed to signify a mental disorder.

    Some believe that there is no essential criterion or set of criteria that can definitively distinguish all cases of disorder from nondisorder (Lilienfeld & Marino, 1999). In truth, no single approach to defining a psychological disorder is adequate by itself, nor is there universal agreement on where the boundary is between disordered and not disordered. From time to time we all experience anxiety, unwanted thoughts, and moments of sadness; our behavior at other times may not make much sense to ourselves or to others. These inner experiences and behaviors can vary in their intensity but are only considered disordered when they are highly disturbing to us and/or others, suggest a dysfunction in normal mental functioning, and are associated with significant distress or disability in social or occupational activities.


    REFERENCES

    American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi. books.9780890425596

    Barker, P., & Buchanan-Barker, P. (2010). The legacy of Thomas Szasz. Center for Independent Thought. http://www. centerforindependentthought.org/SzaszLegacy.html

    Bourguignon, E. (1970). Hallucinations and trance: An anthropologist’s perspective. In W. Keup (Ed.), Origins and mechanisms of hallucination (pp. 183–190). Plenum Press.

    Buchanan-Barker, P., & Barker, P. (2009, February). The convenient myth of Thomas Szasz. Journal of Psychiatric and Mental Health Nursing, 16(1), 87–95. https://doi.org/10.1111/j.1365-2850.2008.01310.x

    DNA project aims to count Scots redheads. (2012, November 7). BBC News. http://www.bbc.com/news/uk-scotland-20237511

    Fabrega, H. (2007). How psychiatric conditions were made. Psychiatry, 70(2), 130–153. https://doi.org/10.1521/psyc.2007.70.2.130

    Lilienfeld, S. O., & Marino, L. (1999). Essentialism revisited: Evolutionary theory and the concept of mental disorder. Journal of Abnormal Psychology, 108(3), 400–411. https://doi.org/10.1037/ 0021-843X.108.3.400

    Oliver, J. (2006, July). The myth of Thomas Szasz. The New Atlantis, 13(13), 68–84. http://www.thenewatlantis.com/docLib/TNA13-Oliver.pdf

    Patterson, M. L., Iizuka, Y., Tubbs, M. E., Ansel, J., Tsutsumi, M., & Anson, J. (2007). Passing encounters east and west: Comparing Japanese and American pedestrian interactions. Journal of Nonverbal Behavior, 31(3), 155–166. https://doi.org/10.1007/s10919-007-0028-4

    Pazain, M. (2010, December 2). To look or not to look? Eye contact differences in different cultures. Examiner.com. https://web.archive. org/web/20160618201038/http://www.examiner.com/article/ to-look-or-not-to-look-eye-contact-differences-different-cultures

    Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15(2), 113–118. https://doi.org/10.1037/h0046535

    Szasz, T. S. (1965). Legal and moral aspects of homosexuality. In J. Marmor (Ed.), Sexual inversion: The multiple roots of homosexuality (pp. 124–139). Basic Books.

    Szasz, T. S. (2010). The myth of mental illness: Foundations of a theory of personal conduct. HarperCollins. (Original work published 1961)

    Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388. https://doi.org/10.1037/0003-066X.47.3.373

    Zachar, P., & Kendler, K. S. (2007). Psychiatric disorders: A conceptual taxonomy. American Journal of Psychiatry, 164(4), 557–565. https:// doi.org/10.1176/ajp.2007.164.4.557

     


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