Overpathologising: Finding Disorder in Order

As the conversation surrounding mental health disorders is becoming more common, people may be more inclined to seek help for their unconstructive thoughts and/or behaviours. The ever-present stigma and lack of information we may have of certain mental health disorders may cause us to overlook telltale signs. Deviant symptoms may be incorrectly labelled as normal behaviour, leaving a potential mental health disorder undiagnosed. However, what happens when the converse occurs? When culturally accepted thoughts and behaviours are incorrectly labelled as “abnormal”, we may end up incorrectly pathologising a common behaviour [1]. This phenomenon is termed “overpathologising” and this can do more harm than good to the mental health scene. How then can we discern between ‘normal’ and ‘abnormal’ behaviours?

Before we can discuss abnormality, we must first discuss what ‘normality’ means. Unfortunately, there is no easy answer to what is considered ‘normal’. Let’s ask ourselves the following questions:

• How many days of grieving is considered as ‘normal’?
• How many hours of crying over an embarrassing event is considered ‘normal’?
• Is it ‘normal’ to be apathetic towards the tragedy of a stranger?

As you would have already guessed, there is no straightforward answer to these questions. Furthermore, you would find that these answers depends on culture. People from different cultures would answer these questions differently and thus have different ideas of what is considered ‘abnormal’. Therefore, if we are to define abnormal behaviour in this article, it would be defined as “being inconsistent with an individual’s developmental, cultural and societal norms.” [2] 

We can further define abnormality in the mental health context as “causing considerable distress, danger and dysfunction to one’s life”. 

Pathologising in the mental health context refers to “view or characterise as medically or psychologically abnormal.”​​ [3]

Pathologising is not a recent phenomenon. In fact, most of our medical fields operate on pathology. In psychology, this is evident in the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM 5 discusses mental illnesses in great detail, from causes, symptoms to treatment [4].We have been pathologising human existence by spotting disorders and managing them with our existing knowledge since a long time ago. Of course, pathologising is by no means a negative thing since it has helped us to identify problems and teach us the appropriate ways to manage those problems.

The problem lies not in pathologising, but overpathologising. Overpathologising, as the name suggests, is an extension of pathologising but to a more extreme degree. We may inaccurately or excessively pathologise, and find problems even where there aren’t any. 

Let’s take a case study used by Beidel, Bulik and Stanley (2010) in their abnormal psychology textbook of a cautious man [2]:

“Robert is a very cautious person, He does not like to make mistakes and believes that the behaviour standards that he sets for himself are high but fair… Before leaving his house or going to sleep, he walks through the house, checking to make sure that every door and window is locked and the oven and stove are turned off. This usually takes about 5 minutes.”

For some of us, we may find that Robert’s behaviour aligns to cultural norms. Some of us may even relate to his behaviour. However, for someone who is overpathologising, they would be finding abnormality in Robert’s behaviour. For example, they may find that his behaviour is concerning, and may be more aligned to that of someone who has an anxiety disorder, or even Obsessive Compulsive Disorder (OCD). 

Social media has undoubtedly made communication and sharing information much easier. It connects us with people with real, lived experiences and we can use it to find solidarity and social support where we cannot in real life. However, social media makes content not only accessible but relatable to its users while being unregulated [5]. 

We may observe a few social media posts online raising awareness of various mental health conditions. Such posts can educate the general public on accurate, useful information. It can encourage those who are concerned about their behaviours and thoughts to seek professional help. It can be especially helpful for those who cannot afford a diagnosis as these resources are easily accessible through the internet. However, we may notice that these posts are rather vague and can apply to most of the general public. Most of these posts may also be non-professionals giving advice on mental health issues. 

For example, it is not wrong to say that having trouble concentrating is one of the signs of Attention Deficit Hyperactivity Disorder (ADHD). Despite that, we should also recognise that most of us may have trouble concentrating from time to time. However, that does not imply that we have ADHD. Hence, discernment on one’s end is important when engaging with such mental health-related content online to prevent jumping to conclusions and overpathologising. 

In all, we shouldn’t lose the advocacy of mental health awareness in a bid to be relatable or to fit into a certain social group. This is especially with vaguely worded social media posts or worse, through the spreading of false information.

It is true that we can never be too careful when it comes to mental health and illness. However, there are some disadvantages that come with overpathologising. 

A study done by Dewak (2023) acknowledged that self-diagnoses can sometimes be accurate, though there is still a likelihood of misdiagnosing oneself. 

Deawke (2023) also mentions the term “overdiagnosing” which refers to diagnoses made based on “slight or short-lived” symptoms that do not require medical intervention. This is largely due to the vast information made available online. When both misdiagnosing and overdianogsis occur, it can result in emotional distress, feeling stigmatised and amplified emotional reactions.

As we have discussed earlier in this article, defining abnormal behaviour is not easy when it’s already hard to define what is normal. Overpathologising can complicate the already blurred lines between “abnormal” and “normal”.

A study by Billieux and colleagues (2015) found that addiction was commonly used to describe various excessive behaviours [7]. As we know, we live in the age of information technology where we are inevitably on our phones and computers a lot. This applies to most people across age groups. However, is it appropriate to call this hike in screen time an ‘internet addiction’? To what extent does doing something excessively become an “addiction”? Billieux and colleagues (2015) acknowledge that specific behaviours such as excessive internet usage can cause dysfunction and other negative effects. However, they maintain that when we overpathologise, it can broaden the definition of certain disorders to include culturally appropriate, everyday behaviour. Given our developing world today, using our phones have become culturally acceptable. 

This is problematic as it makes it harder to conceptualise, diagnose and treat specific disorders. Further, it can be harder for someone to get the mental health resources and treatment they require due to the complexity of overpathologising.

We would like to stress that there is no harm in using mental health resources online to understand oneself better, for self-improvement, or to diagnose a possible mental health concern we have based on our own discernment. However, we must be critical when faced with such content online. Disorders are often characterised by the intensity, persistence, and level of distress and dysfunction that it brings into one’s life. For example, major depressive disorder is more than just ‘feeling sad’. Likewise for anxiety disorders such as OCD, it is more than just being hygienic, or wanting things to be neat and organised. 

Secondly, it is important to recognise that mental health and mental illness exist on a spectrum rather than in binaries. For example, if we take a look at the Diagnostic and Statistical Manual of Mental Disorders (5th edition), we notice that one of the listed symptoms for anxiety is sleep disturbances and feelings of fatigue [8]. Most of us would be familiar with such an experience. Sometimes, we lose sleep because of stress, and as a result, feel a sense of fatigue. However, that does not necessarily mean that we have an anxiety disorder In fact, we may simply be experiencing anxiety or stress which is a common human experience.

This means that while we are experiencing some symptoms of anxiety disorder, it is not at the intensity that it warrants the label of a disorder. This can be clearer when we realise that these symptoms often go away together with our stressors. 

We can seek professional help to deal with our mental health related symptoms if they are beginning to interfere with daily living, cause distress, and persist even without stressors. 

[1] Positive Psychology. (2020). “What is Pathologizing & Overpathologizing in Psychology?”. Theory & Books. Retrieved August 3, 2023 from https://positivepsychology.com/pathologizing/#overpathologizing. 

[2] Beidel, D. C., Bulik, C. M., & Stanley, M. A. (2010). Abnormal psychology (p. 640). Boston: Prentice Hall. 

[3] Merriam-Webster. (n.d.). Pathologize. In Merriam-Webster.com dictionary. Retrieved August 3, 2023, from https://www.merriam-webster.com/dictionary/pathologize

[4] Maddux, J. E. (2008). Positive psychology and the illness ideology: Toward a positive clinical psychology. Applied Psychology, 57, 54-70.

[5] i-D. (2021). Why do we love to pathologise normal behaviour online? Retrieved August 3, 2023 from https://i-d.vice.com/en/article/pkbywn/tiktok-pathologise-normal-behaviour-mental-health

[6] Dewak, H. (2023). Scrolling for a Diagnosis: The Effects of Self-Diagnosing Content on Social Media on Young Adults’ Mental Health (Bachelor’s thesis, University of Twente).

[7] Billieux, J., Schimmenti, A., Khazaal, Y., Maurage, P., & Heeren, A. (2015). Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Journal of behavioral addictions, 4(3), 119-123.

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