in youths: deviancy, disability, and distress (Cicchetti, 2016a; Dulcan, 2019).
One approach to defining abnormality is based on statistical deviation. Using this approach, abnormal behaviors are defined by their relative infrequency in the general population. For example, transient thoughts about death are fairly common among adolescents. However, recurrent thoughts about killing oneself are statistically rare and could indicate a mood disorder, such as depression. Consequently, psychologists might administer a rating scale to clients and identify youths who show symptoms well beyond the normal range, compared to other children and adolescents of the same age and gender (Achenbach, 2015).
The primary limitation of the statistical deviation approach to defining abnormality is that not all infrequent behaviors are indicative of mental disorders. Imagine a child who is tearful, prefers to stay in her room, does not want to play with friends, and is having problems completing schoolwork. From the statistical deviation perspective, we might diagnose this girl with depression because she shows mood problems that are rare among girls her age. However, if we learn that her grandfather died a few days before her assessment, we would likely interpret her behavior as a normal grief reaction, not as an indicator of depression. Although statistical infrequency may be an important component of a definition of abnormality, it is insufficient by itself. Statistical deviation does not take into account the context of children’s behavior.
A second approach to defining abnormality is based on disability or degree of impairment. From this perspective, abnormal behavior is characterized by thoughts, feelings, or actions that interfere with a child’s social or academic functioning. For example, an adolescent who feels sad because she broke up with her boyfriend would not be diagnosed with depression, as long as she is able to maintain relationships with friends, get along with her parents, and perform adequately in school. On the other hand, her behavior might be considered abnormal if she has difficulty in any of these three areas.
Defining abnormality by level of disability has a serious drawback: Many youths with psychological disorders do not show obvious signs of impairment. For example, 15-year-old Dorothy Dutiel killed herself and a classmate at her high school in Glendale, Arizona. Dorothy obtained a gun from another classmate who did not know that she was depressed and intended harm. After the incident, first responders found a handwritten note in Dorothy’s pocket that read, “I would like to clarify that [the student who gave me the gun] and his family are in no way affiliated with my actions. He was under the absolute impression I needed the gun for self-defense. I lied to receive this gun.” Dorothy’s classmate was unaware that she was depressed because she spent time with friends, continued to do well in school, and did not appear sad. Not all mental health problems are accompanied by overt impairment (Lynch, 2018).
A third approach to defining abnormality includes a child’s degree of emotional distress. People can show distress through depressed mood, irritability, anxiety, worry, panic, confusion, frustration, anger, or other feelings of dysphoria.
One problem with defining abnormality in terms of distress is that distress is subjective. Although signs of distress can be observed by others (e.g., sweaty palms, flushed face), we usually need to measure distress by asking children how they feel. Some young children are unable to report their feelings. For example, they may complain of physical symptoms like headaches or stomachaches instead of negative emotions. Other children have trouble differentiating their feelings. For example, they might not be able to tell the difference between feeling “angry” and “hurt.” To complicate things further, there is no objective criterion by which we can evaluate the intensity of children’s distress. For example, a child who reports feeling “bad” might be experiencing more distress than another child who reports feeling “terrible.”
©iStockphoto.com/monkeybusinessimages
A second problem with defining abnormality based on distress is that many youths with serious behavior problems do not experience negative emotions. For example, some adolescents who engage in harmful and destructive behavior show no signs of anxiety or depression. They may only experience sadness or remorse when they are caught and punished. Similarly, younger children with oppositional and defiant behavior toward adults rarely express psychological distress. Instead, their disruptive behavior causes distress in others, like their parents or teachers (Image 1.2).
A Harmful Dysfunction
Jerome Wakefield (1992, 1997) offers an alternative, influential approach to defining abnormal behavior based on the notion of harmful dysfunction. According to this approach, a behavior is abnormal when two criteria are met. First, the person must show a dysfunction—that is, a failure of some evolutionarily selected internal mechanism to work in the correct manner. Second, the dysfunction must cause harm; it must limit the person’s life activities or threaten their health and well-being in some way (Widiger & Mullins-Sweatt, 2018).
To understand the two criteria, let’s look at an example from the field of medicine. Heart disease is a medical disorder because (1) it involves an abnormality in the functioning of the body’s circulatory system and (2) this underlying dysfunction can cause disability or death. Similarly, Wakefield argues that the harmful dysfunction criteria can be used to identify mental health problems. For example, depression is a disorder because (1) it involves an inability to effectively regulate one’s emotions and (2) this underlying dysfunction can cause impairment, distress, and self-harm (Wakefield, Lorenzo-Luaces, & Lee, 2018).
Review
Professionals disagree about the best way to define abnormal behavior in children and differentiate it from normal childhood functioning.
Three features of abnormality include (1) statistical deviation or infrequency, (2) disability or impairment, and (3) distress.
Jerome Wakefield proposed the harmful dysfunction definition of abnormal behavior. A behavior is abnormal if it reflects an underlying dysfunction in a biological or psychological system and it causes disability or distress.
How Does DSM-5 Define Abnormality?
Definition
In the United States, most mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose mental health problems in children and adults (American Psychiatric Association, 2013). The DSM-5 definition of a mental disorder reflects Wakefield’s notion of harmful dysfunction and emphasizes the role of disability and distress in differentiating normal and abnormal behavior:
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. (American Psychiatric Association, 2013, p. 20)
It is worth noting that DSM-5 describes people with mental disorders as “usually” experiencing significant disability or distress—they may not always
