When And Why Do Symptoms Get Pathologized?

Pathologizing refers to the process in medicine and psychiatry where physical symptoms or psychological behaviors are classified as unhealthy or abnormal. In medicine, these are not a result or consequence of lifestyle factors or circumstances. When a symptom or a form of behavior is pathologized, it gets classified and referred to as a disorder or a disease. 

However, when pathologizing behavior in psychiatry and psychology is considered, the discourse may be more complex. People may wonder who decides what normal vs. abnormal behavior is and the reasons behind these decisions.

What is "normal" behavior?

What constitutes "normal" is a subject up for much debate. The definition of "normal" behavior can be subjective, depending on societal norms and standards. Similarly, what is considered "normal" can differ from one culture to the next. Even within a given community, differing views can exist on what constitutes acceptable behavior.

For instance, homosexuality or identifying with the LGBTQIA+ community were considered "abnormal sexual practices" in Western countries until 1973. In the first Diagnostic Statistical Manual of Mental Disorders (DSM), homosexuality was classified as a "sexual paraphilia" rather than a valid sexual orientation. Today, many modern societies view sexuality, the gender binary, and other aspects of personal identity as identities, not examples of abnormal or dangerous behavior. 

This example may show how changing social expectations can impact how individuals view certain behaviors and experiences. What may seem "abnormal" could be a deviation from what popular culture showcases. The categorization of some traits as "normal" and others as "abnormal" relies on the assumption that there are correct and incorrect ways to exist. 

What kinds of behaviors are pathologized?

Despite challenges in defining what is normal, guidelines for diagnoses and mental illnesses can be helpful when developing effective treatments. Behavioral patterns that harm the individual participating in them, others, or both are often of concern to mental health professionals. 

Instead of labeling these behaviors as "abnormal," they might be defined by an impairment in functionality or quality of life and a lack of ability to form and maintain healthy relationships. As such, the impact of symptoms may be more indicative of a challenge than labeling the symptom itself. 

Internationally, there are systems of classification used to help professionals recognize and diagnose symptoms of a potential mental health disorder. The International Classification of Diseases (ICD) and the DSM are widely used options. 

International classification of diseases (ICD)

The first edition of the ICD was known as the "International List of Causes of Death." The International Statistical Institute adopted it in 1893 and entrusted it to the World Health Organization (WHO) at its inception in 1948. Since then, the ICD has been subdivided into more classifications, including:

• The International Classifications of Diseases for Oncology (ICD-O)

• The Application of the International Classification of Diseases to Neurology (ICD - 10 - NA)

• The Application of the International Classification of Diseases to Dentistry and Stomatology (ICD-DA)

• Two ICD Classifications of Mental and Behavioral Disorders: One for clinical descriptions and diagnostic guidelines and one for diagnostic criteria for research

In the 1960s, the WHO mobilized its Mental Health Program to improve the diagnosis and classification of mental disorders in the ICD. The WHO convened this with the help of an international group of representatives from multiple disciplines and various schools of thought in psychiatry. Simultaneously, a network of centers and individuals was established worldwide, aiming to improve the work of psychiatric classification.

The WHO continues to collaborate with many worldwide, including the American Psychiatric Association (APA), which is responsible for updating and revising the Diagnostic Statistical Manual.

Diagnostic statistical manual of mental disorders (DSM)

In 1952, the American Psychiatric Association (APA) adapted the ICD-6, and this adaptation became the first edition of the DSM. It contained descriptions of the diagnostic categories and is the first official manual of mental disorders, focusing on clinical use in psychiatry and psychology. 

Since then, the DSM has been revised four times, with the latest (DSM-5) appearing in 2013. It was compiled by work groups that created a research agenda starting in 2000. These groups produced hundreds of white papers, monographs, and psychiatric journal articles to summarize the state of psychiatric science relevant to diagnosis. The purpose of this effort was to determine where research showed gaps. In 2007, a specially designated DSM-5 task force was formed to revise the previous DSM. 

Symptoms become pathologized through extensive research, evaluation, classification, and categorization that has been ongoing since the 19th century. Diagnostic manuals are constantly evolving based on input from expert analysis and worldwide research.

Classification aims to assist clinicians in understanding and treating specific problems. If clinicians do not have a working list of classifications and symptoms, they may be unable to coordinate or understand what treatments might best help the individual. 

ICD and DSM classifications also assist insurance companies and treatment providers in paying and receiving payment for services. Insurance companies determine what illnesses of any type are covered. 

By requiring doctors and other providers to use a standard set of diagnostic labels and symptoms, insurance companies can quickly determine if treatment will be covered and if they approve of the treatment provided. Insurance companies often only cover research-driven treatments that have demonstrated effectiveness in multiple peer-reviewed and analyzed studies and clinical trials. 

Is labeling helpful? 

Despite the constant growth of diagnostic tools and the purposes of their use, they remain controversial. This controversy stems from the stigma that is often associated with diagnostic labels given to clients. Some mental health professionals decline to use diagnostic labels for this reason. If being diagnosed concerns you, speak with your treatment provider. 

Understanding their diagnosis and the accompanying label feels helpful for some people, as it gives them a name for an experience. How you feel about labels is up to you, but it can be valuable to note that behaviors listed in the DSM-5 or ICD-11 that describe "abnormal" symptoms don't necessarily define you as a person. 

Counseling options 

A mental health professional, like a therapist or counselor, may be able to help you navigate the topic of labels and diagnosis. However, you don't have to have a diagnosis to attend therapy. In addition, you don't have to pay excessive amounts of money to see a provider. Through online therapy platforms like BetterHelp, you can find cost-effective support, convenience, and availability. 

Research supports the effectiveness of online therapy for treating mental health symptoms, including those related to depression, anxiety, PTSD, and other mental illnesses. One literature review of studies analyzing the efficacy of online cognitive-behavioral therapy (CBT) found that treatment led to significant decreases in symptoms of anxiety and depression. It also noted that similar results were found in clients with panic disorder.