In this video I describe characteristics that are important for determining whether traits or behaviors represent potential symptoms of a disorder. These mostly focus on deviance, dysfunction, and distress, though danger and duration also play a role in identifying symptoms. Next I discuss the challenges of diagnosis and the need to find a balance between objectivity and the inherently subjective nature of the psychiatrist-client relationship.

Video Transcript

Hi I’m Michael Corayer and this is Psych Exam Review. In the previous video we talked about concepts of normality and abnormality in trying to determine what represents mental illness. We also talked about the medical model for diagnosis this was the idea that disorders or syndromes have characteristic patterns or clusters of symptoms associated with them and so what a psychiatrist does is look at the pattern of symptoms that a person is expressing and then try to determine which disorder or disorders the person might be suffering from.

And in this video we’re going to look more closely at the idea of symptoms. How do we determine whether or not something represents a symptom of a mental illness or if it’s a normal trait or behavior? And there are some keywords that we can focus on that all start with D in order to determine whether or not something should be considered a symptom of mental illness. These are deviance, dysfunction, and distress. So deviance refers to thoughts or behaviors that are considerably different from the thoughts and behaviors of most people. This is mostly what we focused on in the previous video thinking about how do we determine what’s normal or abnormal and obviously this is not easy to do as we saw. But one question we can ask is what most people do this in the same circumstances, and circumstances are important. So for instance if you jump up on a table and start singing at the top of your lungs, if you’re at a rock concert then this might be considered normal. You might say most people would do that in the same circumstances or many people would do that in those circumstances. But if you were to exhibit the same exact behavior jumping up on the table and singing at the top of your lungs in the library, now might people say that’s deviant. Most people would not do that in those circumstances and so the same behavior might be considered deviant in different context. And so this brings in the role of social and cultural norms in the process of trying to diagnose and determine what things are considered symptoms.

But of course deviance alone is not enough to make something a symptom. We also look at dysfunction. So when we say that a symptom is dysfunctional what we mean is that it’s maladaptive or it interferes with normal life. Now that of course brings that loaded term of how we determine what normal is, but generally we can say something is dysfunctional if it interferes with the person’s ability to form social relationships, if it interferes with their job performance, or if it interferes with everyday tasks, the sort of necessary tasks of daily life that one has to accomplish. And so if a trait or a behavior is getting in the way of those things then we say it’s dysfunctional. Now of course dysfunction alone is not enough to make something a symptom. You might have, you know, something like a personality trait that impairs your social relationships, so you might be a very disagreeable person and you find it hard to get along with others and you could say that impairs your social relationships, that doesn’t mean on its own that it’s a sign of a mental illness.

And lastly we consider distress, and so distress refers to whether a trait or behavior causes pain or upsets the person who is experiencing it. So then we’d say it’s distressful, and so generally these are traits or behaviors that people wish they didn’t have. They say it’s interfering with my life, it’s dysfunctional, it’s deviant, it’s something that most people don’t do, and it’s painful for me to experience. I wish that I didn’t have this behavior. I wish I didn’t have this trait or this thought pattern or something like that.

Now there are a few exceptions where the distress is on other people. So if you have something like antisocial personality disorder and you inflict harm upon other people but you don’t feel bad about it, you don’t feel remorse, in that case we would say there’s still distress even if the person who is engaging in these behaviors is not the one experiencing the distress. But generally we’re going to think of the distress as happening to the person who is exhibiting the symptoms.

Now this brings us to a few other related D words. And the first of these is danger. So when something represents a danger to the person themself or to other people then we might consider it could potentially be a symptom of a mental illness. Now of course the extremes of this are easy to bring to mind, people think about risk of suicide or somebody engaging in violent aggressive behavior towards others, but danger can include more mundane dangers. Things like maintaining a safe living environment; so if somebody has something like a hoarding disorder and so they have all sorts of things piling up in their home making it unsafe to live there, there’s a greater risk of fire or they’re unable to escape in an emergency, then we’d say that represents a danger.

And lastly we had the idea of duration and there’s the idea that many of the symptoms of mental illness are things that people experience and they experience them only for very brief periods of time. And so the duration matters in determining whether or not this represents a symptom of illness or not. So for instance, many people most people have probably experienced a depressed mood but often it’s very brief if it only lasts for a day or two we have an idea of what depression feels like. That doesn’t mean, of course, that we have depression and so there’s a big difference between feeling depressed mood for a day or two and feeling it for several weeks. And so that can be an important distinction when trying to determine is my depressed mood a symptom of a mental illness or is it just that I’m experiencing this depressed mood but in two or three days it will be it will be gone on its own.

And so the frequency and the severity of symptoms also matters and this is one of the big challenges of diagnosis because psychiatrists meeting with potential patients often don’t have a lot of time to assess the duration of these symptoms, the frequency and how severe they are, and so assessing potential symptoms in brief consultations represents a problem. On the one hand we might say that would be better to have more consultations over a longer period of time. The psychiatrist could get a better assessment for the frequency severity and duration of these symptoms. On the other hand we might say well we don’t want to stretch out the length of diagnosis. There are some people who might benefit from an immediate diagnosis and in that case we don’t want to say that you know you have to have ten consultations with a psychiatrist before you receive your diagnosis and you’re able to start getting treatment. And so we have to try to find a balance between how much we can assess the duration, the frequency, and the severity in a brief consultation and how long are we willing to wait where we might potentially be withholding treatment from people who could get it sooner if we made a faster diagnosis.

And so one way that psychiatrists try to get around this is the use of semi-structured interviews and these involve open-ended questions that give the patient a chance to express themselves to talk about their experience with the symptoms that they have and this helps the psychiatrist to try to get a feel for the severity of these symptoms. We can think about psychiatrists as being sort of trapped between two extremes here. On the one extreme we might say we want our diagnosis to be purely objective; we’d like to have clear markers and this engenders a sort of checklist mentality, that okay you have this symptom, you have this symptom, you have this, mm okay; here’s the disorder that you have. It’s very clear-cut. But of course the way that patients are experiencing their symptoms, they probably don’t have a clear-cut way to express that to a psychiatrist, right? They don’t have a nice clear checklist in their mind of the symptoms that they have and just how frequent they are and how they compare to what other people experience in similar situations and so they’re dependent a bit on the psychiatrist for that.

And that means they have to be able to express those symptoms clearly to the psychiatrist and this means this is going to be a bit subjective. And it’s important to have a sense of trust and openness between the client and the psychiatrist and that’s not so objective, and that’s something that the psychiatrist has to keep in mind. We have to try to find a balance between these two extremes; we don’t want to be too subjective in our diagnosis but being too objective might cause patients to withhold certain information and so this is a challenge not just for psychiatrists but for all doctors who are trying to determine which symptoms somebody has, how severe those symptoms are, and what they might represent. So the description and interpretation of symptoms is important and it’s going to vary from patient to patient. We also have the importance of compliance and efficacy of treatment and this is going to involve some trust and a good relationship between the doctor and the patient and we also know that the relationship between the doctor and the patient can play a role in the patient’s overall well-being and that’s something that we’ll return to in a later unit when we talk about treatment. I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!