Causal Context May Influence Psychopathology Diagnosis

Clinicians rely on varying factors to assess a client’s level of mental health. Past events, such as abuse or trauma, can help a clinician determine if the behavior a client exhibits in the present tense warrants psychological treatment. But exactly how does a clinician decide what is normal or abnormal behavior?  “The concept of psychological abnormality has long been, and continues to be, a central concept in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and in a wide range of clinical evaluations,” said Nancy S. Kim of the Department of Psychology at Northeastern University. “Judgments of psychological abnormality most directly speak to the fundamental issue of uncovering clinicians’ true beliefs about what constitutes psychopathology.” In a recent study, Kim asked how casual context influenced a clinician’s judgment. “Our central aim is to propose and test a proportionate-response hypothesis, such that clinicians’ judgments of abnormality are influenced by whether a person’s behaviors are perceived to be a disproportionate response to past events, rendering them difficult to understand or explain.”

Kim presented 77 clinical psychologists with several vignettes describing behaviors that ranged from unaffected to distressed, that resulted from either severely traumatic or mildly stressful events. She found that clinicians deemed the behaviors that mismatched the events as the most abnormal. “In our study, a life event that was mismatched to a set of behaviors in strength and valence led to ratings of greater abnormality relative to a life event that was well matched to the same behaviors,” said Kim. “Thus, even everyday behaviors can be perceived by clinicians to be quite abnormal, depending on the causal context.” The findings raise the question of whether or not clinicians should base their judgments on past events rather than current behaviors and emotions, leading them to create their own suppositions regarding the psychopathology of client that may exist outside the guidelines outlined in the DSM. Kim added, “Overall, given the current data, we recommend that clinicians operate with the awareness that causal context may influence their global judgments about the abnormality of a client’s behaviors.”

Kim, N. S., Paulus, D. J., Gonzalez, J. S., & Khalife, D. (2011, December 5). Proportionate Responses to Life Events Influence Clinicians’ Judgments of Psychological Abnormality. Psychological Assessment. Advance online publication. doi: 10.1037/a0026416

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Maggie W

    Maggie W

    December 29th, 2011 at 5:37 AM

    If I were in therapy or considering that route for a family member I wuld have to have a lot of faith that the person that I led them to would know the difference between abnormal and normal. Isn’t this in essence what they are trained to do? Recognize the things that we do not see with our untrained eyes and help them to get to a place of normalcy in their lives.

  • richard


    December 30th, 2011 at 3:22 PM

    what’s normal n what’s not differs from person to there’s no real baseline that a specialist can having past events of the same person as a reference is a good way forward.yes changes do happen in the same person but then finding out the reason for the change n its consequences is what therapy’s all about,yeah.

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