Psychiatric Deviance

Medicalization and Epidemiology

The Medicalization of Deviance

A number of sociologists and other observers have noted that various forms of deviant behavior as well as other problems of everyday life are increasingly being defined as medical or psychiatric disorders, a process known as the medicalization of deviance. This historical tendency is illustrated by the growing influence of a medicalized conception of deviant drinking as "alcoholism" since the 1930s or by the dramatic increase in the diagnostic labeling and medication of school children. In some school districts, as much as a third of the children have been diagnosed with ADHD (attention deficit-hyperactivity disorder) or similar conditions and placed on stimulant drugs. However, the continuing movement to medicalize deviance is no where more apparent than in the growth in the size and scope of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which is commonly referred to as the DSM. From its origin in 1952 as a brief volume of less than 90 pages of psychiatric diagnoses, the most recent edition, the DSM-IV-TR, has grown ten-fold to over 900 pages! This "Big Book of Labels" includes everything from schizophrenia and other psychotic disorders to anxiety or sleeplessness induced by coffee consumption. A comprehensive list of diagnostic labels from the DSM-IV-TR is available at http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm.

Epidemiology of Psychiatric Disorders

Sociologists and other social scientists have been involved in epidemiological research on the incidence and prevalence of psychiatric disorders for a number of years. Some epidemiological studies have used survey measures that are based on DSM diagnostic criteria to estimate the prevalence of psychiatric conditions in the general population. Based on this measurement strategy, the current prevalence estimate for the adult population of the U.S. is that about 20 percent are affected by mental disorders during a given year. This estimate comes from two epidemiologic surveys: the Epidemiologic Catchment Area (ECA) study of the early 1980s and the National Comorbidity Survey (NCS) of the early 1990s. Those surveys defined mental illness according to the prevailing editions of the DSM (III and IIIR). The surveys estimate that during a one-year period, 22 to 23 percent of the U.S. adult population—or 44 million people—have diagnosable mental disorders, according to reliable, established criteria. In general, 19 percent of the adult U.S. population have a mental disorder alone (in 1 year); 3 percent have both mental and addictive disorders; and 6 percent have addictive disorders alone. Consequently, about 28 to 30 percent of the population have either a mental or addictive disorder. The following table from the Report of the Surgeon General on Mental Health summarizes the results synthesized from these two large national surveys (click here to read report).
ECA Prevalence (%)
NCS Prevalence (%)
Best Estimate ** (%)
Any Anxiety Disorder
13.1
18.7
16.4
    Simple Phobia
8.3
8.6
8.3
    Social Phobia
2.0
7.4
2.0
    Agoraphobia
4.9
3.7
4.9
    GAD
(1.5)*
3.4
3.4
    Panic Disorder
1.6
2.2
1.6
    OCD
2.4
(0.9)*
2.4
    PTSD
(1.9)*
3.6
3.6
Any Mood Disorder
7.1
11.1
7.1
    MD Episode
6.5
10.1
6.5
    Unipolar MD
5.3
8.9
5.3
    Dysthymia
1.6
2.5
1.6
    Bipolar I
1.1
1.3
1.1
    Bipolar II
0.6
0.2
0.6
    Schizophrenia
1.3 1.3
       
    Nonaffective Psychosis
0.2 0.2
    Somatization
0.2 0.2
    ASP
2.1 2.1
    Anorexia Nervosa
0.1 0.1
    Severe Cognitive Impairment
1.2 1.2
Any Disorder 19.5 23.4 21.0

*Numbers in parentheses indicate the prevalence of the disorder without any comorbidity. These rates were calculated using the NCS data for GAD and PTSD, and the ECA data for OCD. The rates were not used in calculating the any anxiety disorder and any disorder totals for the ECA and NCS columns. The unduplicated GAD and PTSD rates were added to the best estimate total for any anxiety disorder (3.3%) and any disorder (1.5%).

**In developing best-estimate 1-year prevalence rates from the two studies, a conservative procedure was followed that had previously been used in an independent scientific analysis comparing these two data sets (Andrews, 1995). For any mood disorder and any anxiety disorder, the lower estimate of the two surveys was selected, which for these data was the ECA. The best estimate rates for the individual mood and anxiety disorders were then chosen from the ECA only, in order to maintain the relationships between the individual disorders. For other disorders that were not covered in both surveys, the available estimate was used.

Key to abbreviations: ECA, Epidemiologic Catchment Area; NCS, National Comorbidity Study; GAD, generalized anxiety disorder; OCD, obsessive-compulsive disorder; PTSD, post-traumatic stress disorder; MD, major depression; ASP, antisocial personality disorder.

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