Author: Mark Moran

Christian Counseling: Demonic Diagnosis in Counseling

Posted on by Mark Moran

Since the demonic is a metaphysical belief without any empirical proof or external verification according to the norms of the empirical method, obviously there is no psychological diagnosis for demonic possession or demonic influence upon mental health within the DSM-V-TR.   This does not mean within the history of pastoral care there has not been cases that were considered demonic in origin and required deliverance or exorcism.  Universally, all human cultures have rituals, as well as theological commentary, on dark forces.  While their etiology and origin stories may differ, the unexplainable belief in the evil and dark forces remains a constant even in the modern world.  It is true many cases of mental defect in the past were attributed to the demonic influence due to lack of scientific explanation and that these beliefs led to further psychological damage to the  person, as well as causing social turmoil but the opposite extreme of modern psychology to reject all spiritual and demonic causes is equally dangerous.  Modern psychology has separated body and mind from soul and has restricted all mental defect to the realm of the scientific method.   This stems from a atheistic and humanistic philosophy.

The rite of exorcism is a spiritual ritual that must in its modern form validate the ritual by first eliminating and natural or mental defect within the person

A proper balance is needed that respects the scientific method but does not become intoxicated with atheistic and humanistic rejection of spiritual realities.  It also involves realizing that all reality is not measured or observed but there remains other sciences of theology and philosophy that have recorded human experiences that point to deeper realities than merely natural cause and effect within empirically observable phenomenon.   Phenomenology is a type of science that looks to judge realities via the experience of the human person.  Within these experiences are numerous other realities that escape the narrow and restricted lens of the empirical method.

So while it is important within psychology and diagnosis not to be caught up in superstition, it is also important to not necessarily neglect the spiritual aspect of humanity from a total atheistic outlook.  Instead, it is important to recognize unexplainable situations, to measure them with reason, rule out all possible explanations and remain open to the person’s spiritual wellbeing.  This involves having resources and referral capability to help clients find the individuals who are able and better equipped to help an individual within these rare and odd cases.

This blog will help clinical as well as non clinical professionals identify rare cases of unexplainable phenomenon and then the proper steps in addressing these issues within a professional and ethical framework that is both beneficial for the client as well as licensed counselor.

Please also review AIHCP’s Christian Spiritual Direction Certification, as well as AIHCP’s Christian Counseling Certification.

A Balance Between Science and Superstition

Where does mental defect end and spiritual affliction? Please also review AIHCP’s Christian Counseling Program

One could contend that if one believes a demon is behind every rock, then one may have serious issues.  One could also contend that those who feel God is talking to them may need a serious mental health assessment to rule out psychosis.   Simply put, if one were to meet a modern day Moses, or Abraham, who said God has spoken to them, then that bold statement would require sufficient proof and evidence.  One can only imagine what neighbors thought of Noah, or for that matter Abraham.  If a person today, like Noah, started to build a large boat in the middle of dry land, most would consider this individual quite mentally ill.  And for that matter, one who would lead their son to the top of a mountain to be sacrificed based upon the voices in his head would immediately be arrested and kept for psychological evaluation!  Yet all these bold claims were verified with bold miracles.  However, these extraordinary events are rare in human history and usually when individuals hear voices or think they are seeing demons, there are natural explanations.  Unlike the pre-scientific world and its understanding of mental illness, modern science has afforded humanity with numerous explanations that were once considered demonic or metaphysical.

This does not mean though that with the dawn of the scientific era that all spiritual occurrences remained explainable.   The opposite error in thinking is to purge all spiritual and metaphysical realities simply because some cases have natural origin.   The fact remains that numerous unexplainable experiences that are have no natural explanation continue to occur.  Individuals continue to experience spiritual revelations, apparitions, as well as, evil encounters with the demonic despite the modern era of science.  Many of these experiences are witnessed and testified by sane individuals and professionals, as well as healthcare professionals who have no explanation for the phenomenon.  Hence, it is important to balance an over superstitious mindset with an agnostic or atheistic mindset.  Science and metaphysics can work together to properly balance care of the body, mind and soul and identify afflictions that are beyond comprehension.

Professionals in healthcare as well as mental health can offer spiritual care in certain settings, as well, in particular cases with willing clients.  Christian and spiritual counselors obviously have more freedom in pastoral settings to identify these issues, but when spiritual experts and mental health experts work together, then a proper balance of care is given that avoids sick spirituality and superstitious thought with the opposite extreme of a psychology that has become blatantly hijacked and poisoned by atheistic humanism.

Differential Diagnosis

There are numerous natural explanations and differential diagnoses that explain many cases that may have formerly been consider demonic.

Within the Catholic Church, prior to any exorcism, a full medical and mental health evaluation is required.  This prevents not only a mockery of the rite, but also protects further damaging the person who is experiencing possible mental health issues.  What may appear as possession could be more so a host of various mental and physiological issues.   These differential diagnoses must be ruled out before any suspicion of a demonic possession or presence is even considered.  The mental and clinical health professional plays a key role in these cases.  The professional counselor may have a person referred by the Church exhibiting certain characteristics and the counselor’s professional diagnosis may be required to rule out all natural explanations, or discover an overlooked mental defect with natural causes.   Some counselors, whether clinical or pastoral, as well. may have clients or patients arrive without referral with stories of demons or even God speaking to them, in which the counselor must deduce if the person is in a state of psychosis, or other mental defect, or truly being spiritually afflicted.  The counselor, whether spiritual or atheistic, must carefully tread these ethical waters as not to impose one’s one religious or lack of religious faith, as well as to respect the cultural and spiritual beliefs of the person.  This does not mean, the counselor should ignore present pathology, but instead should carefully with empathy and compassion work with the person to discover the underlying issue and if without closure, refer the client to someone who can deal with these issues.

Among the possible natural explanations for spiritual voices or demonic affliction can be a host of mental issues that must be diagnosed or ruled out.

Psychosis or any type of hallucinations due to natural explanation or mental defect first need addressed.  In addition to psychosis diagnosis that includes seeing things or hearing things, the counselor needs to investigate if any psychosis may be due to drugs, substances or medications. Obviously certain hallucination type drugs need to be ruled out such as PCP or others.  Within Schizophrenia, multiple symptoms that were once considered in the pre-scientific times as demonic have mental origins.  Schizophrenia manifests not only hallucinations but also delirium, disorganized speech, catatonic behavior, numbness and stupor as well as negative symptoms including affective flattening, alogia or avolition (DSM-V-TR, 2022).  In addition, Dissociative Disorder or formerly Multiple Personality Disorder presents the existence of different personalities within the same person.  This manifestation is due to early childhood traumatic experience which cuts away from reality and terror to protect the self by a new identity (DSM-V-TR, 2022).  It is easy to understand how the pre-scientific mind could misconstrue this as a demonic presence.  In addition, physical ailments can also cause hallucinations.  This includes tumors and brain injury.  It is imperative that scans, as well as blood work is conducted to rule out these basic explanations for possible interpretation of demonic manifestations.   Finally, one needs to rule out possible malingering.  Some individuals may fake, lie or try to fabricate symptoms for attention (DSM-V-TR, 2022).  Others may want attention or have a weak sense of the spiritual or their faith.  They mistake what is demonic for natural.  Some may have a fanatic view of faith and indeed look to use supernatural activity  as a way to gather praise or sympathy from others.  Only until this due diligence of ruling out natural explanations is completed, can one begin to contemplate a spiritual issue.

This not to say a seasoned exorcist can sense the demonic far sooner, or for that matter, present individuals who face various mental disorders with also spiritual origins attached, but it is extremely important for the mental and physical safety of the person to ascertain with clarity the etiology and source of the manifestations.

Signs of the Metaphysical

Manifestations of the demonic.

So what is an exorcism?  An exorcism is liberation from a diabolical entity or force that is controlling the host person (posession).  Exorcism is scripturally based and is a power given by Christ to His apostles to cast out demons in His name.  Exorcism throughout the ages has taken on the form of a rite within the Catholic Church with detailed prayers, rituals and preparations.  It involves a fasting and a holy priest who receives authorization from the local bishop to perform the rite.  In Protestant churches, it is referred to as deliverance ministry.  Deliverance ministry does not have the same prayers or rituals found in the rite of exorcism within the Catholic Church.

An exorcist or deliverance minister with experience can sense the signs usually quickly but there are some manifestations or oddities that point to something far more nefarious than only mental defect.  While the demonic can thrive within mental defect and use it, outward signs usually manifest in cases of demonic infestation, oppression, obsession or possession (Amoth, 2016).   Among these signs include unnatural strength of the possessed, unnatural contortions beyond natural explanation, fear of Christ’s name or holy objects, unknown knowledge, utilization of ancient languages, levitation, temperature within room,  and supernatural occurrences such as flying objects (Ripperger, 2022).  Another sign from a clinical standpoint is a person’s inability to heal from a potential diagnosis.  Despite multiple medications, the issues remain.   When these things manifest, it is ultimately the person’s choice for deliverance or exorcism.

Etiology of the Demonic Possession

All demonic activity is limited in scope and practice.  God allows it to exist due to free will but the actions of the demonic can only go as far as His authority permits it.  Any possession or time of liberation is based upon the time appointed by God.  Possession can occur for the greater glory of God, or occur because of one’s own mishaps and missteps.  While all mental defect and suffering is correlated with sin and the continued presence of the demonic in the fallen world, not all mental defect is directly caused by supernatural forces, but behind many forms of suffering exist multiple demonic forces.  Scripture speaks of demons of suffering and the associated temporal pain with it, as well as the demonic and its association with various vices.   Due to actual sin, the human soul weakens its union with God and opens itself to demonic influence.   Demonic influence cannot breach freewill but it can become more persuasive to the soul that walks away from God and grace. Sinful practices that become habitual and more extreme weaken the soul to demonic influences.  Souls that wander farther from God have less spiritual defenses.  Their natural spiritual immune system weakens and as their spiritual hygiene deteriorates the more easily cracks open for spiritual and demonic infection.   Bear in mind, not all extraordinary manifestations of the demonic such as infestation, oppression, obsession and possession are always due to spiritual decline.  In the case of the saints, many times, spiritual oppression occurred where God permitted the saints to heroically battle the demonic for His greater glory.

Priests many times face individuals of possession who unwittingly dabbled in the occult

Demonic influence is not always a long process, but sometimes can happen quickly or in the moment.  Individuals who dabble within the occult or witchcraft can become victims of diabolical possession.  Some may ignorantly fall under such influence through ouija boards, divinization, astral projection, spells, or occult ceremonies and then unknowingly and unwittingly become subjugated to the demonic.  Others can face daily difficulties through generational curses (Amorth, 2016).   Some voluntarily enter into demonic contracts through witchcraft and Satanism.   Through unclean rituals, they allow themselves to be possessed or overtaken for special powers or gifts.   It is important to note in any such contracts, they is not binding upon acceptance of Christ but the consequences of liberation can be difficult, not just from a supernatural element but also within the occult community which may seek vengeance.  In addition, contracts for success and power always end sourly for the individual for the demons are princes of lies (Ripperger, 2022).

Professional Standards and Approaches when Confronted with Demonic Possession

Again, there is no manual for demonic possession within the DSM-V-TR.  For many it is considered outside the scope of professional practice.  This is why it is very important, if as a believer, a mental health professional adheres to standards and protocol.  Professional ethics prevents discussions of spiritual matters unless the client addresses or asks about spiritual aspects.  Spirituality is obviously very critical to mental health.  Since it is so important, spirituality on numerous occasions filters into the counseling session. It is important that this aspect of counseling is introduced only at the interest of the client.  Furthermore, if as a counselor, sharing in different theological views, it is important sometimes to set boundaries or refer clients to other counselors who may be better equipped to discuss spirituality.   For those of faith, these conversations are not as difficult.  Most of faith integrate spirituality at an implicit level of practice.  They quietly pray to the Holy Spirit for guidance and healing of patients, while others can have a more explicit integration with clients who openly profess faith.  Obviously this is far more easy a practice for Christian Counselors, faith based ministries, or counseling organizations with a Christian mission.

Yet, there still can be many pitfalls.  First, many spiritual people can sometimes have distortions of faith.  While faith experiences are exempt from delusionary behavior in the DSM-V-TR, many can experience spiritual events that need to be properly discerned for their authenticity.  Some counselors are better equipped to handle these situations, while others should refer a client to a Christian or faith based counselor or a minister or spiritual director or priest.  These individuals can help clients better discern spiritual communication from God, or for that matter, spiritual discernment regarding demonic manifestations.  In addition, deliverance prayers, or pray healing can present serious issues for purposes of billing.  Since they are not a recognized medical therapy (Note: prayer needs to be carefully integrated into any session for those who desire it) Finally, deliverance and exorcism is far different than mere prayers but involves deep emotional, psychological, mental and spiritual goals and aims.  Only trained professionals who are approved should ever pursue these types of spiritual exercises.  First, it is extremely dangerous for the person if mishandled both mentally and spiritually.  Secondly, the possibility of malpractice sky rockets.  Third, it is not recognized within norms of care.  And finally, it is extremely dangerous for the counselor to perform exorcism or deliverance.  Exorcism not only involves intense training, but it also requires spiritual preparation dictated in Scripture.  It involves faith and it involves a calling.  Thus, anyone manifesting symptoms of diabolical possession should be referred to the appropriate religious professional.  Counselors should have a list of adjunct professionals they can contact regarding these extraordinary issues. Obviously, before anything can be referred or conducted, the person must grant full consent and give permission.

Christian Counselors can help an individual discern spiritual experiences, help lead in prayers, advise and offer solutions.  Spiritual cleaning and spiritual direction can help the soul face issues, but if diabolical presence is more than temptation and simple obsession or infestation, a trained exorcist will be required for more serious matters.   When matters are more serious, they seem to keep returning, especially if the person is unwilling to change certain life styles that have attracted the presence, or refuses to take the proper spiritual care at home, protecting it and self.

Christian Counselors can offer binding prayers, sacramentals of protection, moral guidance and references, but sometimes, a soul needs liberation at the hands of a qualified religious professional.  Again under no circumstance, should a counselor, or even a Christian Counselor attempt to exorcize a person.

Conclusion

Helping individuals with spiritual issues involves balancing superstition against atheism. It involves a middle ground that accepts the spiritual aspect of humanity. Please also review AIHCP’s Christian Counseling Certification as well as its Christian Spiritual Direction Program

Demonic possession is a reality that many deny.  Understanding the the presence of Satan in the world and its many levels is important because it affects all levels of humanity.  Mental health and spiritual health are integrated realities and many times both affect each other.  While not every issue is demonic or directly correlated, it is very dangerous to dismiss this reality.  Mental health professionals play a key role in diagnosing mental disorders and helping religious professionals dismiss fake possession for true mental defect, or by ruling out all natural differential diagnoses.  This helps the religious professional or exorcist understand if he is dealing with a true demonic case.  Many Christian counselors or even clinical counselors may come across cases of the supernatural and must follow their own ethical standards.  In cases of possession, clients should be referred to the appropriate religious and pastoral professionals.  Clinical counselors or even Christian counselors should never attempt to perform an exorcism.

Please also review AIHCP’s Christian Counseling Certification.

 

Additional Blogs

Types of Demonic Activity.  Access here

References

Amorth, G. (2016). “An Exorcist Explains the Demonic. Sophia Institute Press.

DSM-V-TR, 2022

Rippeger, C. (2022). “Dominion: The Nature of Diabolic Warfare”. Independently published.

Additional Resources

Fragomeni, R. (2023). “What is an exorcism?”. U.S. Catholic.  Access here

Somers, J. (2023). “What Actually Happens When You Request An Exorcism” G.  Access here

“What is deliverance ministry, and is it biblical?” Got Questions.  Access here

 

 

 

What is Psychopathology? Video Blog

Posted on by Mark Moran

Understanding psychopathology is critical to understanding a large portion of human health.  This video takes a closer look at psychopathology and the importance of acknowledging one’s own mental health minus any stigmas.  Please also review AIHCP’s Behavioral Healthcare Certification Programs including Grief Counseling, Trauma Informed Care, Anger Management, Spiritual Counseling and many more!

Christian Counseling and Etiology of Psychopathology

Posted on by Mark Moran

Pathology is disease and sickness.  With disease and sickness is the result of suffering and death.  These concepts are all intimately tied to the human condition which begs the question “why must we suffer”?  Different philosophies have different explanations throughout time.  Secular sources recognize pathology as the natural order of evolution.  Psychopathology and any pathology is part of life as organisms live and die within the cosmic struggle of existence.  Pathology is treated in the present moment and its etiology is categorized according to an empirical process of elimination based upon categories of biological causes, psycho-social causes and cultural causes.   Religious traditions also vary.  Buddhism and Hinduism recognize suffering as central to the human condition.  Buddhism seeks to escape the pathologies and resulting suffering of this world through Nirvana or the becoming into nothingness, while Hinduism recognizes this world as a great illusion and suffering as a result of karma.  Monotheistic creeds consider suffering to be a result of deviance from God’s moral law.  Christianity, in particular, recognizes suffering not merely as deviation from God, but also a broken human condition as a result of that deviation.  Individuals are born into this world subject to suffering.  Hence, as a result of sin, humanity experiences a traumatic condition, its consequences and also the continuance of sin itself in actuality (Boerger, et. al., 2023).   Sin, according to St. Thomas Aquinas, is thus a disordered action from God which leads to disastrous consequences that naturally include pathology.

In this blog, we will examine these concepts, but look deeper from a Christian Counseling perspective of an etiology that encompasses sin as the core root of pathology and how integration of modern psychology and pastoral care can emerge to a more holistic and complete care of not just mind and body, but also soul.  Please also review AIHCP’s Christian Counseling Certification, as well as its Christian Grief Program and also its Christian Spiritual Direction Certification.

Theodicy

Since pathology is part of life, humanity experiences suffering and death.  At the core root and etiology of it is sin, yet this suffering and pain seems so unfair.  The death  and gross genocide of a population at the hands of a ruthless regime, the death of an young child to cancer, or the devastation of a storm to a community all point to a horrific world marred by sorrow.  When individuals refuse to acknowledge sin and its corruption of the natural design, it leads to anger towards God.  The question within Christian theodicy is how can a good and all powerful God permit evil? Kelly, 2002) Either God is not all powerful to prevent the evil, or He is not all good to permit it.  This classical attempt to limit one to either/or confuses the reality of human and angelic free will and its part in the cosmic story of temporal reality.   Free will is what guarantees sentience.  God has given sentient creation made in His image the choice to love or hate Him.  When disordered response emerge in free willed creatures, horrible consequences occur.  God was willing in His foresight to permit these evils at the expense of free will.  One can only include that the price of free will is essential to being made in the image and likeness of God.

Unlike other faiths or philosophical explanations of evil in the world, the Christian worldview believes in a God who through Jesus Christ, both God and man, died for His creation to repair the spiritual damage of sin with promise of eternal life free of suffering.  God, through Jesus, did not allow His creation to suffer alone but came as an example to expose the temporal world for its folly, and to suffer with humanity and ultimately die for it.  This is the ultimate act of mercy and justice grounded in infinite love.

Soul Care and Modern Psychology

Care of the soul and mind is essential in treating psychopathologies. Please also review AIHCP’s Christian Counseling Certification

Psychology before the advent of Sigmund Freud was more likened to pastoral care for the mind.  Within it existed not only age old wisdom collected from Scripture, patristic fathers, and medical knowledge of the times, but also an element that acknowledged that beyond the mind existed the soul.   With this metaphysical prerequisite, care of the soul equated to treating many pathologies from a religious and spiritual perspective (McRay, et al., 2016).   This allowed certain conditions of the mind to be seen in correlation with states of the soul.  Concepts of sin, its consequences, the habitual growth of vice in the soul, and the forces of the demonic were all considered when tying things to depression, anxiety, sexual deviations, or even anti-social disorders.  Of course, the primary issue was that pre-scientific minds were limited in the study of pathology.  This led to an over emphasis of explaining everything as a result of the unseen and in some cases superstitious understandings of mental defect.  Modern psychology corrected this but went a step even farther that eliminated any emphasis of soul care.  Empiricism and the scientific method over corrected the imbalance, removing any concepts of metaphysical causes or the need of care of the soul.  Instead, modern science attempted to eradicate metaphysics all together since metaphysics is a non-observable study.

The modern scientific method corrected many superstitious ideals and labeled unknown pathologies to their proper etiologies but in its clean sweep of all metaphysical explanations, it reduced itself to a sterile tool only capable of abstracting data from observable phenomenon.  Concepts of sin or its correlation with mental defect were removed and the idea of the soul was attempted to be completely explained within the physiology of the brain.  Modern and secular science boasted it had mapped the “soul” to the brain and reduced it to a physical origin.   This led to a new imbalance.  Instead of a pre-scientific mindset which over attributed all pathology to the unseen, the post-scientific mindset attributed all pathology only to the observable and natural.

Christian Worldview

A Christian worldview is a religious and metaphysical worldview.  Uniquely different than other religious and metaphysical views, it considers the physical world to be broken with death and suffering.  It considers the temporal world to be a flawed design that was not originally intended by the Creator but marred because of sin or deviation from God.   First, the disobedience the demonic and then followed by the sin of Adam created a disturbance in creation that led to discord.  For humanity in particular, the sin of Adam thrust humanity into the temporal reality.  Genesis states that due to Adam and Eve’s sin, death entered into their world.  St. Augustine coined the term for this as “Original Sin” (Lamoureux & Wadell, 2010).  Original sin corrupted the nature of humanity.  Before, Adam contained great knowledge, control of his passions, and an inclination towards good that was not clouded to disorder, but after his fall, humanity’s nature, albeit not totally corrupted, was disorientated away from God.  With this traumatic state, grace was cut off from the soul and humanity’s body was subject to suffering, pathology and death.  Hence, a new condition, its consequences and continued deviance resulted in the fall of Adam.

A Christian worldview acknowledges the disorder of sin and its consequences as the core and universal starting point for all pathology.

Redemption came through Christ who paid the price of sin.  Through Christ’s death as the perfect priest and perfect victim, the infinite debt and injustice was paid and God’s mercy and reconciliation was granted to humanity.  Through grace earned by Christ and dispensed through the Holy Spirit, the spiritual consequences of sin and its metaphysical wounds were healed, but the the physical broken condition and consequences of Original sin remained.  So while the debt of sin was paid, its lingering consequences of a disordered nature, pathology and death still remained in the temporal reality.

A Christian world view accepts the brokenness of human nature and the role sin has played in marring the world, but also  maintains a hopeful future with God since the spiritual death has been paid in full by Christ for those willing to accept it.

The Importance of Recognizing the Metaphysical In Pathology

As pointed out, when everything in psychopathology is reduced to demons or sin, or the opposite, when everything in pathology is reduced to the observable, there exists an imbalance.  A good balance recognizes that not every illness or mental defect is a direct result of sin, or a devil, but within the norms of the modern psychology has its source in natural and explainable phenomenon.  This balance also acknowledges, however, that many defects are more than physical but also tie directly to the soul and deeper metaphysical realties, such as demonic influence or vice.  When metaphysical realities are neglected or dismissed, then a  more complete care of the total person is lost.

For instance consider these mental disorders.

Depression and anxiety are unsettled emotional states.  Modern science and the DSM-V-TR has given insightful diagnosis to their symptoms and etiologies.  At a biological level, they are tied to imbalance of serotonin for depression and GABA in anxiety.  While there are other neurotransmitters that play key roles, for brevity, just consider these elements tied with multiple psycho-social implications of trauma, abuse, low self-esteem, and behavioral practices.   All of this paints a picture of why melancholy exists within the person but what if there are deeper issues afflicting the person that are beyond the temporal?  What if at a deeper state, the low self-esteem is tied spiritual disorder?  What if despair and rejection of God’s mercy is at play, or even worst, demonic oppressive thoughts tormenting the person (Amorth, 2016). Many times, resistant depression has deeper issues that SSRI’s cannot rebalance because they are not temporal but metaphysical in origin.  The original source is the brokenness and until that original source is recognized, the person may experience physical symptoms or relate to a particular event, but the nature of the underlying issue is not exposed until spiritual issues are addressed.  Whether these issues are self imposed through sinful and destructive habit or encouraged through demonic influence.  It is no wonder that in many cases exorcisms reveal the names of demons by their vice or pain inflicted upon the person (Amorth, 2016).

Another example includes paraphilias or sexual deviations.  Modern psychology identifies disorders as things that cause impairment not based on objective reality of right or wrong but upon cultural and social norms, as well as mental functioning.  Deviations are only considered wrong when impairment occurs or harm to self or others exists.  This differential treatment of morality avoids a particular religious bias but also ignores the source of the disorder which is primarily a rejection of God’s moral law and the natural purpose of the conjugal act.  It ignores the lustful mutation of the sexual act, as well as the underlying demonic sources surrounding this distortion.  How can one truly find healing with these disorders when the actions themselves are not condemned.

Finally, for brevity, one last example includes anti-social personality disorders.  While modern psychology attempts to understand the brain of sociopaths, narcissists and psychopaths, their behavior includes numerous conditions that lack empathy, compassion, and love for others.  Instead, their malignant will chooses themselves over others.  These actions become imposed upon their very character and nature as to be as natural as breathing.  This attempt to explain evil behavior based solely on biological factors, as well as psycho-social and traumatic early childhood events is lacking.  These types of individuals are not just programmed wrong, but their soul is also sick.  They chose at one point actions tied to vice that eventually became habitual to form a sinful character.  Tying together the new neuro processes of their mind with a sick spirituality is a far more complete explanation.

Virtue and Vice are parts of life.  Individuals who cultivate virtue, lead to behaviors and characters that become naturally virtuous and good while those who cultivate selfish, proudful, lustful, or hateful actions lead to be behaviors and characters that are bad.   Modern psychology cannot by itself label these things due to its restricted empirical lens, but when tied with theology and spirituality, one can probe deeper and identify these malignant issues and face them.

An integrated Christian view with modern psychology represents a stronger balance in meeting the etiologies of pathology from both a scientific and metaphysical team that does not look to under or over emphasize each other (Johnson, 2010).

A Psychological and Spiritual Treatment

Healing through proper orientation is key in pastoral care.  The vice tied to a mental pathology is identified and the pastoral work involves cultivating the opposing virtue.  Individuals dealing with paraphilias receive spiritual direction and moral support in cultivating temperance and the virtue of purity in conjunction with various proven behavioral therapies that help reframe and rewire the neuropathways.  Those facing depression, would focus on God’s mercy and love, as well as the virtue of hope and faith to counter the vice of despair, but the psychological and pharmaceutical treatments would concur with them.  Or again, individuals facing personality disorders would focus on humility and charity to counter pride and envy and anger but still receive the critical psychological guidance needed to form better habits and curb certain impulses.

Christian professionals are tied to ethical standards but also sometimes ostracized by secular peers for beliefs or mistrusted by the faithful for their adherence empirical methods of study

These are all examples of uniting psychological and spiritual treatments.  There has existed a grave mistrust between mental health professionals who are secular and those who are religious.  Many religious communities mistrust empirical methods due to the dismissal of God, while many secular communities doubt the professionalism of many religious due to extremism and excessive superstitious beliefs.  There is a place where reason, the scientific method and faith can coexist when properly balanced.  This is well seen in the Catholic Church which has thoroughly integrated the process of exorcism.  Unlike the Middle Ages, where any mental defect that was misunderstood was considered demonic or a hex, modern science has afforded the faith to utilize its tools to rule out mental defect before proceeding into the rite of exorcism (Amorth, 2016).  It is only logical when treating mental pathology to follow the critique of science before assuming the metaphysical to rule out hysteria and superstitious belief.  This is not a sin against faith, but a logical narrowing of mental defect from true metaphysical occurances.

The religious professional faces a twofold mission.  First to convince their fellow secular colleagues of their qualifications and empirical knowledge, so as not to become ostracized and secondly to convince the local church to understand the importance of the scientific method as a tool that is when used properly is not hostile to the faith (Johnson, 2010).

In addition, the religious professional is sometimes tied to ethical standards.  Their role as a counselor in a secular setting demands the creation of a therapeutic atmosphere that encompasses empathy, unconditional regard and safety to speak without judgement or be viewed with bias.  Their role in a religious setting changes when it becomes pastoral and the need to guide with moral clarity manifests.  This can be conflicting and sometimes difficult but the key is to identify the particular role and function at a particular time and the service being rendered (Johnson, 2010).

Conclusion

It is important to identify a proper etiology of mental psychopathology.  This involves balancing spiritual and empirical causes of mental defect without causing an imbalance or extreme in other direction.  The Christian worldview presents a view that sin is the ultimate cause of pathology in the world and that care involves pastoral as well as clinical guidance.  The care of the person must not just include body and mind, but also soul.  Prior times over-emphasized the spiritual causes of mental defect and pathology, but when properly balanced, one can find an effective and integrated way that addresses all the needs of the totality of the person.

Please also review AIHCP’s Christian Counseling and Spiritual Direction Programs

Please also review AIHCP’s Christian Counseling Certification, as well as its Spiritual Direction Program.

References

Amorth, G. (2016). An exorcist explains the demonic: The antics of Satan and his army of fallen angels. Sophia Institute Press.

Boerger, J. (2023). The original wound: Considering sin as trauma and psychopathology as the disintegration of human personhood. Journal of Psychology and Christianity.  42(4). 307-321

Collins, G. (2007). Christian counseling: A comprehensive guide (3rd ed). Thomas Nelson.

Johnson, E (ed) (2010). Psychology and Christianity: Five Views (2nd ed). IVP Academic

Kelly, J. (2002). The problem of evil in the western tradition: From the book of Job to modern genetics. The Liturgical Press

Lamoureux, P. & Wadel, P. (2010). The Christian moral life: Faithful discipleship for a global society. Orbis Books

McRay, B, Yarhouse, M. & Butman, R. (2016). Modern psychopathologies: A comprehensive Christian appraisal (2nd ed). IVP Academic

 

Additional AIHCP Blogs

Diagnosing Psychopathology.  Access here

What is Psychopathology.  Access here

Additional Resources

Psychology and Christianity: Exploring the Five Views of Integration. (2024).  NeuroLaunch.  Access here

Abercrombie, W.P. (2013). Psychopathology or Sin? BSI. Access here

Tarrent, J. (2025). “Spiritual Awakening or Psychopathology?”. Psychology Today.  Access here

 

 

 

Christian Spiritual Direction Video Blog on Spiritual Discontent

Posted on by Mark Moran

Spiritual Directors can help individuals see happiness in a different light from spiritual perspectives.  This in turn can lead others away from discontent and a better understanding of thie relationship with God.  Please also review AIHCP’s Christian Spiritual Direction program

Christian Counseling, the DSM-V-TR & Sexual/Paraphilic/Gender Deviations & Issues

Posted on by Mark Moran

Forewarning, this blog presents adult topics regarding a sexual nature but also from a Christian perspective for purposes of Christian Counseling and Direction.  As a program of AIHCP, the content regarding morality is for purposes of Christian Counseling and sexuality not official views of AIHCP.  Regardless, the material presented represents a detailed and academic description of these issues and presents the various understandings of them, while maintaining a Christian mandate that requires love and respect of differing opinions regarding the subject.  For those of differing morality and faith or sexual orientation, please feel invited to still review in an attempt to foster better understanding of different views.

Please also review AIHCP’s numerous spiritual based programs in Christian Counseling, Christian Spiritual Direction,  general Spiritual Counseling and Spiritual Trauma Informed Care.

DSM-V-TR /Sexuality/Christian Worldview

Love and sex can become distorted within the DSM-V list of paraphilias. Please also review AIHCP’s Christian Counseling Program

Correlated with the free love movement of the 1960s, there has been a shift in society’s view of morality.  This is not to say that sexual morality was restructured by the movement, but it did challenge the then existing social norms regarding sexuality in regards to public discourse outside the bedroom and also looked to challenge the Judeo-Christian morality that dominated these social norms.  What was once labeled “sinful” or at least socially not publicly consumable became more open to the masses and questioned.  In addition, society itself and its definitions of marriage, gender and appropriate sexual interaction became redefined. The DSMs also evolved with the changing perceptions.  This was not just due to the cultural shift of a more open sexual morality in the public sphere, but also as science and psychology advanced, new studies and discoveries about the human brain and its development emerged which forced the DSM to re-evaluate the sexual norm.  This led to various acts that were once considered a disorder to not even be listed.  For instance homosexuality as a way of life became a non-disorder and an equally healthy mental and emotional way of expressing love.  The DSM-IV as it evolved into the present DSM-V in 2013 also emerged with different understandings of gender identity reversing the title of Gender Identity Disorder to Gender Dysphoria.   In addition, multiple paraphilias became labeled disorders only if harming others, self, or causing impairment (DSM-V-TR, 2022).

From a Christian Counseling perspective this has caused some friction.  The Christian worldview is at odds with many secular and  sexual actions .  What is seen as a disorder also can carry the weight of sin within itself – at least with action tied to the thought.  Furthermore, various paraphilia which carry  negative values in Christian morality are reduced to alternative drives that if not causing harm to others or self, or causing impairment, then become not spiritual problems but only mental.  This is expected to some extent since psychology is a science and should not be biased with religious belief.  Sexual deviations should be listed in a scientific and non-biased way that does not reflect one religious morality over the other but it does show a shift in what was once considered a disorder.  One can even speculate that some of the science itself may have become biased based upon the new social norms shaping it.  These are issues that Christian Counselors must acknowledge within the DSM-V-TR and learn to properly integrate the science of the DMS-V-TR with a Christian world view when counseling in a pastoral setting.

So what is the Christian worldview on sexual morality before continuing?  The Christian world view holds to an objective morality that is binding upon everyone that is based within Scripture and Christian tradition, theology and morality.  It recognizes that humanity is fallen and mental illness is a result of sin (McRay, et al., 2016).  It views sexuality and gender as a gift from God for purposes of reproduction, but also unifying love between husband and wife.  It recognizes two sexes that are tied to only two genders.  It holds that God created male and female and saw that this was good.  Christian Counseling, especially integrated Christian Counseling does not reject mental illness as an ingredient for sinful actions.  Furthermore, Christian Counseling does not look to judge others but to merely understand not only the morality but also the psychology of the person in helping individuals find a healthy spiritual, emotional and mental health that is tied to Christ.  This  means that sexual morality must coincide with one’s moral actions, despite urges, and that one must accept the commandments and follow Christ.  Christian Counseling recognizes failure and sins, but it does not look to marginalize one particular group but to hold all sexual sins accountable to God.  Unfortunately, many Christians condemn one group’s sins over another group’s of sins.  For instance, it can appear at times that some Christian churches will single out homosexual sins or Transgender sins over the sexual sins of heterosexuals.

Due to the fall, human nature has become inclined to sexual sin.  It can easily gravitate towards these sins and become engulfed with the sin of lust (McRay,  et al., 2016).  Not all sexual sins are deviations from the norm, but all sexual sins still nonetheless lead one away from God and corrupt His original design and intention.  Christian Counseling recognizes this fall, the need of Redeemer in Christ and the need for sanctification of the Holy Spirit in everyday life.  While some may not be tempted in the area of lust as others, it still remains a powerful urge that can be corrupted into deeper immorality.  This is the goal of the demonic.   Sadly, due to the fall of humanity, many also suffer not only from the vice of lust, but are also afflicted with mental disorder, or unnatural urges.  Many of these urges are not choices but come to the person and can be stronger due to a variety of biological issues.   These individuals not only face a temptation but also mental issues.  In this way, Christian Counseling not only recognizes many paraphilias as mental disorders but also sins.  In treating the paraphilia, it is more than just merely recognizing impairment or harm to self and others, but is also understood in a spiritual way.    This spiritual focus in Christian Counseling recognizes many paraphilias as sins within themselves and unnatural to the sexual act not merely in a physical way but in a completely body, mind and soul way.  It recognizes the role mental health plays in spiritual warfare with the devil and how treating many of these disorders also requires spiritual and pastoral care.  In this way, the DSM-V-TR serves as tool but a tool that only brushes the top of the surface.

Paraphilias of the DSM-V-TR

Paraphilias distort and corrupt God’s original plan for man and woman

The DSM-V-TR lists many odd, as well as socially unacceptable paraphilias.  In definition, the DSM-V-TR recognizes paraphilias as “any intense or persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners (2022)”.  According to the DSM-V-TR a disorder differs from a mere urge and thought in that the intensity is causing impairment, harm to self or others, as well as becoming the dominant of way of sexual expression over normal means.  In this way, the value of morality based on right or wrong is merely replaced with these thoughts as deviation from the norm without any moral questions.  Of course, one may question this distinction between thought and action when discussing pedophilia or zoophilia or necrophilia.  Are the presence of these thoughts not a disorder within themselves because they are so unnatural?  While acting upon a urge is far worst, the presence of these urges represent a serious problem within themselves that should not require impairment or harm of others or self to red flag it. As it stands, zoophilia (sexual intercourse with animals), necrophilia (sexual attraction or intercourse with corpses) as well as urophilia (urine) and coprophilia (feces) all find classification with the DSM-V-TR under “other specified paraphilic disorders”.

Other than the “other” list, the DSM-V-TR lists 8 paraphilias with diagnosis for disorder again to include impairment of quality of life in all areas, as well as harming oneself or others.  Many of these disorders are inherently tied to harm of others, while others can be merely addictive in nature.  Interestingly enough, pornography is not even listed as an addiction, much less a deviation although it is gateway to many of these disorders and can become a type of disorder if it inhibits social and professional activities.

Voyeurstic Disorder

This involves an intense and recurrent interest and sexual arousal over a 6 month period of observing other naked people or watching them engage in sex without their consent.  The person must be at least 18 to differentiate between adolescent curiosity versus a full blown disorder.  For diagnosis as disorder it requires action taken on these urges and if these fantasies or actions lead to significant distress or impairment in social, occupational or important areas of functioning (DSM-V-TR, 2022).

Exhibitionist Disorder

This involves intense or recurrent sexual arousal  over a 6 month period regarding exposing one’s genitals to an unexpecting person.  Specifiers include the target audience as children only, adults only, or both (DSM-V-TR, 2022).

Frotteuristic Disorder

This involves intense or recurrent sexual arousal over a 6 month period from touching or rubbing up against unexpecting and nonconsenting individuals (DSM-V-TR, 2022).

Sexual Masochism Disorder

This involves intense and recurrent sexual arousal over a 6 month period from being humiliated, beaten, bound, and made to suffer.  It can have a specifier tied to strangling or asphyxiophilia (DSM-V-TR, 2022).

Sexual Sadism Disorder

This involves intense and recurrent sexual arousal over a 6 month period in the suffering or causing of suffering in another human person.  This disorder is tied to bondage-domination-sado masochism where two disorders interact in bondage.  The sadism in this particular case is not ruled as a disorder if with a consenting adult.  However, sadists are tied to sexual crimes and rape, albeit, most rapes are still tied to control and authority than mere pleasure of others pain (DSM-V-TR, 2022).

Pedophilic Disorder

This involves intense and recurrent sexual arousal over a 6 month period with prepubescent children under the age of 13 years.  Specifiers include those who are attracted to only children, or both children and adults, as well as those attracted to only males, females or both (DSM-V-TR, 2022).  Obviously this disorder, like sadism also carries legal and criminal prosecution, beyond just being a disorder, much less within Christian theology a horrible sin.

Fetishistic Disorder

This involves intense and recurrent sexual arousal over a 6 month period with objects, or nonliving things with a high focus on non-genital body parts (DSM-V-TR, 2022).

Transvestic Disorder

This involves intense and recurrent sexual arousal over a 6 month period from crossdressing (DSM-V-TR, 2022).

All of these disorders above relate to sexual deviations from the social norm.  In this way, psychology does not necessarily give to them a moral value.  Instead psychology looks at impairment, harm to self and harm to self and others.  This does not mean that these thoughts in themselves are not dangerous and sinful.  In addition, many of these disorders can become addictive.  Starting with the smallest thing, pornography can open a window of deviations which hamper a person’s social functioning.  Individuals then become slaves to their passion of lust and it begins to dominate the person.  From a Christian perspective, this is the goal of the demonic.  The goal is to corrupt, mock and displace sexuality with crude and disgusting acts and use human beings as the tool leading them farther away from God and deeper into addictive and dark practices.  These actions look for pleasure and gratification as the primary purpose of sexuality.  However, the norm of sexual expression or attraction ceases to arouse, so one slowly goes deeper and deeper into corruption.  This not only dismisses the original intent of the conjugal act, but it also reduces people to things and objects to find pleasure.  Whether consenting or not, it still represents a a deep corruption (McRay,et al. 2016).

Mental health can biological factors can play a role in the deviations, but also trauma, sexual abuse, and mistreatment in one’s  youth.  Others never learn about sexuality or how to properly express it.  Not surprisingly, many of the differential diagnoses of these actions are also tied to impulse control disorders as well anti-social personality disorders (DSM-V-TR, 2022).

Gender Dysphoria

Gender dysphoria is incongruence between physical sex and perceived gender and the anxiety resulting from within

As sexual orientation and gender idealogy became more prominent within the social norms of modern society, the DSM-V responded as well with less emphasis of any mental defect in regards to gender identity, much like previous versions adjusted to mental diagnosis of same sex attraction.  The current trend is to one day even remove gender dysphoria as it did prior with homosexuality from the manual, but many lament if diagnostics do not remain, then this may affect gender altering elective surgeries for purposes of medical insurance and payment.

As it stands gender dysphoria in itself does not point towards a disorder but only when impairment, anxiety, depression and suffering result from it due to a lack of congruence between assigned sex at birth and chosen gender (DSM-V-TR, 2022).   Due to this, the DSM-V carefully redefines sex and gender.  Sex is defined as biological and physical manifestations of male or female.  It is also referred to as the birth assigned gender or assigned sex.  Gender, according to the DSM-V denotes the social, cultural and public role a person chooses as a boy or girl (2022).    When someone does not adhere to the assigned birth they are said to be gender atypical, gender nonconforming, gender diverse, or gender variant (DSM-V-TR, 2022).   One’s gender identity is what one adheres to, which can be male or female, or even gender fluid which is neither male nor female.  Transgender refers to a broad spectrum of individuals whose identity is different than their assigned sex at birth.  However, only if incongruence and distress occur, does the DSM-V-TR list it as a disorder within itself (2022).  A transsexual is a person who has undergone surgery altering procedures to their physical/biological appearance as male or female.

The DSM-V-TR points out that gender dysphoria can be both experienced in children but also with adolescents and adults.  In its diagnosis, the DSM-V-TR lists the following as criteria for children and adults.  For both groups, the first criteria requires a marked incongruence between ones expressed gender and assigned gender at birth for a period over 6 months.  In children, the manifestations include.

  1. strong desire to be the other gender
  2. with boys, crossdressing
  3. strong preference for cross gender roles in play and make believe
  4. strong preference for toys of the opposite sex
  5. strong preference for playmates of the other gender
  6. rejection of toys associated with opposite sex
  7. strong dislike of one’s anatomy
  8. strong desire to possess characteristics of the other sex

Within adults

  1. marked incongruence with assigned sex
  2. strong desire to rid oneself of one’s primary and secondary sex characteristics
  3. strong desire for sexual characteristics of other sex
  4. strong desire to be the other gender
  5. strong desire to be treated like the other gender
  6. strong conviction that one has the feelings or reactions of the other sex

Specifiers include if one was born with a sexual abnormality or congenital defect such as adrenogenital disorder, adrenal hyperplasia or androgen insensitivity.    For these individuals, there is less mental perception but a reality that one was physically born with varying degrees of both genitals.  Many within this category of DSDs require immediate medical intervention and surgery when sex is assigned at birth (DSM-V-TR, 2022).  This often results in some type of gender dysphoria in what gender they align with.

It is extremely important to show intense care for especially children who express these symptoms in life.  Many in teen years are going through changes that may be only temporary, or dealing with a body dysmorphic disorder.  Some, in the case of girls, may just be the classical tomboy.  Hence from a purely secular perspective, any major operations or assignments should be withheld until adulthood.  In addition, from a Christian perspective, it is important to help children understand their gender and work with them.  For many, Gender Affirming Therapy can help individuals come to congruity with their gender and sex (McRay, et al., 2022).  While this group represents a very small percentage of the population, their inner turmoil is real.  Empathy and nonjudgement are critical.  These are not choices but true inner turmoil.   Christianity teaches that this inner turmoil is a result of sin but the disgust with one’s body can also be demonic in origin.  Satan wishes for humanity to hate itself from the original design of the Creator.

Etiology and Treatment

Moral decisions about sexuality are very personal.  They touch not only the mental aspect of oneself but also the very spiritual.  When spiritual understanding of sexual issues are disconnected from the mental, it can cause a deeper misunderstanding of the sexual paraphilias.  From a purely mental and biological perspective, trauma, abuse, anxiety, and sexual experiences as child or teen can play a big role in not only sexual paraphilias but also sexual disorders. Experts also agree that psychosocial factors play a large role in paraphilia as well as sexual dysfunctions that stem from poor communication skills and inabilities to form meaningful relationships (McRay, et al., 2016).  Rape victims obviously can have trauma that is innately tied to the conjugal act.  Others may have experiences with conjugal sex at an early age which misshaped their future experiences.  This can lead to a variety of inabilities to sexually function.  These types of sexual disorders are also listed in the DSM-V.  They lead to physiological issues that affect sexual performance, or also negatively affect sexual arousal or even sexual interest.

However, the darker deviations while also tied to past trauma or events, or even some biological markers within the brain have spiritual origins.  This is where the DSM-V-TR as a tool has reached its limit to help.  The darker issues of sexual deviations are tied to sin, lust, vice and addiction.  They can transform into deeper issues if not met on the spiritual battlefield.  Christian Counselors need to be aware of the mental issues behind them but they must also understand how these mental issues are utilized by the enemy to distort the moral fabric of a person’s soul in regards to a host of immoral sexual actions.  Lust is a distortion of love.  Lust rejects temperance.  Lust corrupts the heart to see God.   It is of no wonder then that this capital sin is employed so frequently by the enemy to lead the soul away from true happiness and true design.  Lust ultimately leads to addictions that become more demanding and more perverse until the person loses sight of control and respect of one’s body and others.

Treatments usually only include treating the symptoms of anxiety or depression or the past trauma associated.  More dangerous and predatory in nature paraphilias sometimes require peer groups and also legal intervention.  Those seeking to avoid dangerous sexual behavior need to remove themselves from places that facilitate their urges.  Isolating from stimuli is key.  This could involve for a pedophile staying away from a school area, or one to avoid strip clubs, or drink, or even the internet and porn.   Changing behaviors and breaking addictions may require behavioral and cognitive therapies and token systems.  Positive reinforcements.  From a psychoanalytical school, it would involve understanding one’s childhood and why these sexual issues are manifesting.  Christian Counseling can present a blue print of right versus wrong with emphasis on prayer, penance and the formation of virtue.  Virtue of purity and habit takes time but with patience and prayer, God’s grace can transform and help one carry one’s cross.

Conclusion

Christ heals and makes whole the broken. Please also review AIHCP’s Christian Counseling Certification

The four D’s of mental health regarding danger, distress, dysfunction and deviation play a large role in defining disorder (McRay, et al. 2016).  These are based on standards.  Obviously Christian standards will differ from secular standards and create friction between the label of sin.  However, the DSM-V-TR still recognizes the distress sexual paraphilias and even gender dysphoria can cause.  In this Christian Counselors and secular counselors can agree.  This distress robs the person of peace and the sense of being loved.  This is why it is so important to never judge but also try to help individuals who suffer from such deviations.  While one is tied to ones choices and legal consequences, many of these feelings flow through these individuals creating difficulties in life.  Christian Counselors are called to help individuals in distress but also to align oneself with the commandments and God.

Please also review AIHCP’s Christian Counseling Certification

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional AIHCP Blogs

Christian Morality and Sexuality: Access here

Additional Resources

Paraphilias.  WebMD.  Access here

15 Most Common Paraphilias.  Psychology for Mental Health.  Access here

Paraphilic Disorders. APA.  Access here

Signs and Types of Paraphilic Disorders. VeryWellMind.  Access here

Mental Health and Psychotherapy Video Blog

Posted on by Mark Moran

Mental health is health.  Psychotherapy is a proven way to help individuals with mental issues and disorders.  This video looks at mental health and the numerous types of schools of psychotherapy and various therapies that help individuals everyday. Please also review AIHCP’s Healthcare Certification Programs

 

DSM-V-TR & Substance Abuse Disorders and Eating Disorders

Posted on by Mark Moran

Addiction is a powerful thing.  Addiction is a habitual need to keep doing something despite negative outcomes for the taste of a positive reinforcer.   Ironically addiction can be almost anything in excess in life.  It can pertain to an action, such as gambling, gaming, or even sex and sexual acts.  Usually addiction is correlated with substances, food, or drugs.  In this blog, we will focus on substance abuse disorders and eating disorders described in the DSM-V-TR and review diagnosis and etiology of these disorders.

Please also review AIHCP’s Substance Abuse Practitioner Certification Program.

Substance Abuse

Substance abuse is a big problem affecting millions of people. Please also review AIHCP’s Substance Abuse Practitioner Program

Substance use is the involvement and partaking of a particular substance.  Substance use within itself does not entail a disorder.  It can lead to a dangerous outcome or a lesson learned due to a onetime DUI or fine, or severe hangover to never be repeated.  In this case, substance abuse occurred, but a disorder was not existent (Barlow, et al., 2023).   Substance abuse is usually associated with substance intoxication in which the levels of the substance exceed safe and social norms of it.  Obviously some substances within moderation are legal, while other substances are illegal even in moderation.  Unfortunately, substance abuse even once can be a life altering choice when it harms oneself or others.

Substance Abuse Disorders

The DSM-V-TR lists 10 separate classes of substances and drugs with subcategories.  Within these categories include, alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants and tobacco (2022).  In addition the disorders include the behavioral and psychological craving of the substance, intoxication of the substance and the withdraw of the substance (DSM-V-TR, 2022).

Addiction in general to these substances involves a general and universal footprint that transects the various substances.  Within this general diagnostic criteria, the DSM-V-TR lays out these guidelines for a Substance Abuse Disorder

A.  A problematic pattern that leads to significant impairment with at least 2 of the following occurring within a 12 month period.

  1. substance is ingested in larger amounts that intended
  2. unsuccessful efforts to control or limit intake
  3. great deal of time and energy to obtain substance
  4. cravings or strong desires or urges to use substance
  5. recurrent uses of substance resulting in failure to fulfill obligations at home, work or school
  6. continued use despite negative personal, legal and social issues
  7. reduction of occupational or recreational activities in place of substance use
  8. recurrent use in hazardous situations
  9. continued use of substance despite knowledge of the physical and physiological problem
  10. presence of tolerance
  11. presence of withdrawal

The disorder can be specified as mild if 2 or 3 symptoms are present, moderate if 4 to 5 symptoms and severe if 6 or more symptoms present (DSM-V-T, 2022).

This presents the basic blueprint for all addiction with substances.  Intoxication or withdrawal differ from substance to substance.  For purposes of brevity, we will just review a few substances and encourage those with particular interests to review particular substances in the DSM-V-TR.

Alcohol Intoxication 

With recent ingestion of alcohol (depressant), clinical problematic behavioral and psychological changes include inappropriate sexual or aggressive behavior, mood lability,  and impaired judgement.  Physical symptoms include one or more of the following, slurred speech, incoordination, unsteady gait, nystagmus, poor attention and poor memory,  and stupor or coma (DSM-V-TR).

Alcohol Withdrawal

Alcohol addiction is very common and can exist at numerous levels

Two or more of the following issues develop after cessation of heavy and prolonged drinking.  Autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient visual, tactile or auditory illusions, psychomotor agitation, anxiety and generalized tonic-clonic seizures (DSM-V-TR, 2022).

Cannabis Intoxication

With recent ingestion of cannabis, clinical problematic behavioral and psychological changes include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, and social withdrawal.   Two or more of the following symptoms can manifest including conjunctival injection, increased appetite, dry mouth and tachycardia (DSM-V-TR, 2022)

Cannabis Withdrawal 

Three or more of the following issues develop after 1 week of heavy or prolonged use of cannabis.  They can include irritability, anger or aggression, nervousness or anxiety, sleep difficulty, decreased appetite, restlessness, depressed mood, or at least one physical symptom of abdominal pain, tremors, sweating, fever, chills or headaches (DSM-V-TR, 2022).

Opioid Intoxication

Common Opioids- Heroin, hydrocodone, oxycodone, fentanyl (Barlow, et al, 2022)

With recent ingestion of opioids, clinical problematic behavioral and psychological changes include initial euphoria followed by apathy, dysphoria, psychomotor agitation, retardation and impaired judgement.   Pupillary restriction can occur.  In addition drowsiness, or coma, slurred speech and impairment to attention and memory (DSM-V-TR, 2022).

Opioid Withdrawal

Three or more of the following issues develop after cessation of heavy or prolonged opioid use.  These include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea (tears or runny nose), pupillary dilation, sweating, diarrhea, yawning, fever or insomnia (DSM-V-TR, 2022).

Stimulant Intoxication

Common Stimulants- Amphetamines ( crystalized-Methamphetamine), (Adderral), Cocaine (Crack in crystal form) (Barlow, et al, 2022)

With recent ingestion of stimulants, clinical behavioral and psychological include euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, and impaired judgment.  Two or more symptoms include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, nausea or vomiting, weight loss, psycho motor agitation, muscular weakness, respiratory depression, chest pain, confusion, seizures or coma (DSM-V-TR, 2022).

Stimulant Withdrawl

Two or more of the following issues develop after cessation or reduction of prolonged amphetamine use that include fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor retardation or agitation (DSM-V-TR, 2022).

Tobacco Withdrawal

Tobacco withdrawal can occur after daily use for at least several weeks and with abrupt cessation include irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood and insomnia (DSM-V-TR, 2022).

Hallucinogen Intoxication

Common Hallucinogen- Phencyclidine or Angel Dust, LCD or Acid (Barlow, et al., 2023).

With recent ingestion of hallucinogens clinical behavioral and psychological changes include belligerence, impulsiveness, unpredictability, psychomotor agitation,  and impaired judgement.  Symptoms include two or more of the following within an hour such as vertical or horizontal nystagmus, hypertension, numbness, ataxia (Uncoordinated motor movement, dysarthria (impaired speech), muscle rigidity, seizures or coma, hyperacusis (hearing). (DSM-V-TR, 2022).

Eating Disorders

Eating disorders stem from anxiety, body dysmorphia, depression and low self esteem and sometimes even control

Substance misuse can also include how one eats and what one consumes.  In ways, it can become a impulse and compulsion as well due to anxiety, or poor self concept that leads individuals to eat certain ways or binge eat, or to starve oneself or attempt to control one’s weight through purging.  These disorders are very dangerous to overall nutrition and health but also have deep psychological issues.  Among the numerous eating disorders listed by the DSM-V-TR, there are Pica or the eating of nonnutritive or nonfood substances, rumination disorders,  binge eating, as well as the most common Anorexia Nervosa and Bulimia Nervosa disorders.  These disorders usually are tied to control issues, anxiety, low-self esteem, and body dysmorphia (Barlow, et al. 2022).

In regards to the BSM-V-TR,  Anorexia Nervosa meets these diagnostic criteria

A. Restriction of energy intake leading to significant body weight loss.

B. Intense fear of gaining weight or becoming fat and behavior that interferes with weight gain

C. Lack of recognition of the severe loss of weight.

Specifiers include restrictive type in which one has not binge ate or purged within the last 3 months but has severely dieted, exercised or fasted.  The second specifier is binge-eating/purging type in which the person within the last 3 months has self induced vomiting or utilized laxatives, diuretics or enemas (DSM-V-TR, 2022).  Based on one’s weight loss determines mild, moderate, severe or extreme.

Bulimia Nervosa

The DSM-V-TR points out that diagnosis of Bulimia does not occur exclusively during episodes of anorexia nervosa.  In addition, many individuals with bulimia do are average weight and do not appear thin or weakly (Barlow, et al., 2022).  The DSM-V-TR lists these criteria:

A. Recurrent episodes of binge eating which include eating within a certain 2 hour period of time of an amount of food that is larger than most individuals would eat and a sense of lack of control during that period

B. Recurrent and inappropriate measures to prevent weight gain through self-induced vomiting, laxatives, diuretics or other medications and excessive measures.

C. These behavior occur at least on average at least once a week for a three month period

D. Self evaluation of the body is unduly founded regarding shape and weight

Specifiers can include mild, moderate, severe or extreme (DSM-V-TR, 2022).

Binge Eating

Binge eating leads to guilt and disgust

Binge eating is recurrent episodes of eating large quantities of food to find some type of reduction of anxiety or comfort.  These recurrent binges are defined by the DSM-V-TR within the following parameters.

A.  Eating in a discrete period of time within a 2 hour period of an amount of food larger than what would be consider appropriate with a sense of lack of control.

B.  The binge eating is associated with three or more of the following feelings

  1. eating more rapid than normal
  2. eating until uncomfortably full
  3. eating large amounts when not hungry
  4. eating alone because embarrassed for others to see the amount consumed
  5. feeling disgusted, depressed and guilty with oneself after consuming the meal

C. Marked distress regarding binge eating is present

D. The binge eating occurs once a week for three months

E. The binge eating is not associating with Bulimia or Anorexia

The specifiers include mild, moderate, severe and extreme (DSM-V-TR, 2022)

The Problem and Etiology of Addiction

Addiction is not only psychological and behavioral but also genetically and biologically based. Please also review AIHCP’s Substance Abuse Practitioner Certification

Addiction looks for quick fixes.  It looks for pleasure in place of happiness.  The dopamine high is sought at the expense of the serotonin stability of life.  Many are looking to escape life’s problems and maladaptively cope via escapism.  This coincides also with more than stressors and problems but also comorbidity with other mental disorders such as depression and anxiety (McRay, et al., 2016).   In addition, addiction is many times tied to impulse control disorders as well (Barlow, et. al, 2023).

In addition, the activation of genetic and biological markers are passed down from generation to generation.  Individuals can face more than merely a psychological and mental addiction but also develop a physical addiction and disease.  Obviously some substances are more objectively addictive, but for some, genetic predispositions play a key role in whether someone can become addicted to a certain substance (Barlow, et al., 2023).

One reality is addiction is not always about substances, albeit the DSM-V-TR only lists gambling as a disorder, but addiction can take the form of many things if one considers actions to be repeated for purpose of positive reinforcement but with negative consequences.  All three qualities must be present for an addiction.  Hence, one can include activities that exceed moderation and in some way become harmful.  This could include gaming, pornography, or any type of obsession that takes away from quality of life.  Balance and temperance are key factors in maintaining healthy outlooks on things we do in life.

Addiction Treatment

Addiction treatment depends on a person’s willingness and the level of addiction itself.  For many it is a life long cross that involves will power, peer support, avoidance of the substance and its occasions, as well as developing better coping strategies for stressors, as well as anxiety and depression.  For some, it also involves finding deeper meaning in life and finding a spiritual anchor.  AA utilizes a spiritual based plan that holds one accountable to a higher power (Barlow, et al., 2023).

Depending on the depth of the disorder also plays a large role.  Abuse of a substance is different than a disorder itself.  Disorders can be mild, moderate or severe and the level of chemical dependency is subjective upon individuals.  Also, the nature of the substance plays a large.  Substances such as nicotine and opiates are far more addictive than other substances.  Some individuals may require medical treatment during the detox phase and require in patient care at a addiction facility.  Others may require gradual reduction and doses to avoid withdrawal under medical guidance.   Others with less severe conditions may just need intensive out patient care and psychoeducation, but others may require more peer support, as well as psychotherapy that includes CBT, motivational interviewing or even contingency management (rewards for sobriety).  Others may require medications to curb cravings (Naltrexone for drinking) or even cause nausea or discomfort in drinking (Disulfiram)

AA and the emphasis on spiritual meaning and finding something more than addiction is possible.  Many spiritual traditions see addiction as more than merely a physiological problem but also a spiritual one that involves bad sinful habits and sometimes even forms of spiritual oppression.  The practice of virtue over vice is essential in creating a healthy spiritual balance.  The virtue of temperance is key in implementing a long term solution against the vice of immoderation and addiction.  Understanding addiction in all its forms, just not substances, is an important aspect of spirituality and finding a healthy spiritual life.

Conclusion

Whether addiction is a substance or a practice, it involves maladaptive coping to face life and issues.  It involves a habitual need to engage or indulge oneself in something that has negative consequences for the small price of brief positive reinforcers.  For some addiction is mental and behavioral, but for others it can be inherited and activated.  It is important to never allow something to become so powerful over oneself as to destroy everything in one’s life.  Addiction is not fast, it is insidious and slowly seduces and entraps the victim but individuals can escape it with a strong will and peer support.  Finding meaning in something greater than oneself is key to overcoming habitual vice and addiction.

Please also review AIHCP’s Substance Abuse Practitioner Program and see if it meets your academic and professional goals.

Additional Blogs

12 Steps of AA Video blog: Access here

Dopamine and Serotonin in Addiction Process:  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Addiction and Substance Abuse Disorders. APA. Access here

Drug Addiction.  Mayo Clinic.  Access here

Substance Use Disorder (SUD). Cleveland Clinic.  Access here

Hartney, E. (2026). “DSM 5 Criteria for Substance Use Disorders”. VeryWellMind.  Access here

DSM-V-TR & Somatic and Dissociative Disorders

Posted on by Mark Moran

The DSM-V-TR and many psychopathology texts group Somatic and Dissociative disorders together.  In the DSM-V-TR somatic disorders are listed after dissociative disorders which are tied to stress and PTSD.  They both share created realities that are not true but they also differ in direction.  Somatic disorders attach to physical symptoms without no correlating reality or pathology from a physical sense but find their origin in the mind.  Likewise, many are tied to anxiety, or fear of possessing the actual disease associated with the symptoms.   Dissociate disorders are tied to breaks from reality that do not exist as well but more so in the mind and one’s surroundings.  They are tied to trauma and stress.  This leads to derealization and depersonalization, various amnesias and dissociative identity stemming from trauma.  In this short blog, we will review the basis and criteria of diagnosis for different somatic disorders as well as dissociative disorders.

Please also review AIHCP’s Healthcare Certification Programs, as well as its many Behavioral Health Certifications.

Somatic Disorders

Somatic disorders contain symptoms of a disease created by the mind with no real existence of the disease within the person.  Somatic means coming from the mind and manifesting physiological manifestations of a particular physical disorder (Barlow, et, al., 2023).   Similar to Somatic Symptom Disorder is Conversion Disorder.  Freud believed that the energy associated with mental illness could manifest as physical disease in other parts of the body causing motor control issues that were only a product of the mind (Barlow, et al., 2023).

Hypochondria or Illness Anxiety Disorder can leave a person impaired socially constantly seeking professional and medical help costing the health system millions of dollars

The biggest difference between Somatic Disorder and Conversion Disorder was the the type of physical manifestation and mental state.  In Somatic Disorder there are a broad range of persistent physical disorders including pain and fatigue.  These irks and pains cause discomfort throughout the day and lead to intense anxiety within the individual as the person attempts to understand the nature of their illness.  Conversion differs in the manifestation and reaction.  The manifestation effects motor control and cause paralysis, blindness, or other body movement.  It usually follows an immediate stressor and can resolve itself quicker.  Hence individuals do not deal with it longer over a chronological period (DSM-V-TR, 2022).

The DSM-V-TR lists these criteria Somatic Symptom Disorder for diagnosis .

A. One or more somatic symptoms that cause significant disruption in life

B. Excessive thoughts or behaviors tied to the somatic symptoms with at least one of the following:

1. disproportionate and persistent thoughts about the seriousness of the issue

2.  high levels of anxiety about the symptom or overall health

3. excessive time and energy directed to these symptoms and concerns

C.  These symptoms persist for 6 months.

Somatic Symptom Disorder can be specified with predominant pain, persistent symptoms, and as mild, moderate or severe.

(DSM-V-TR, 2022).

 

The DMS-V-TR lists this criteria for Conversion diagnosis

A. One or more of the symptoms have altered motor or sensory function

B. Clinical findings discover no correlation between the symptoms and recognized neurological disorder

C. There is no rational explanation for the disorder

D. The symptom causes clinically significant distress or functioning

It can be specified as acute, chronic, with psychological or without psychological stressor, with various symptom types such as weakness or paralysis, abnormal movement, swallowing symptoms, speech symptoms, seizures, sensory loss, special sensory loss or mixed symptoms.

(DSM-V-TR, 2022).

Another Somatic related disorder is Illness Anxiety Disorder which deviates from Somatic Symptom Disorder in regards to mild to no symptoms with the fear of disease existing in the mind.  In the past it was referred to as Hypochondria (Barlow, et al., 2023).   The DSM-V-TR lists the following diagnostic criteria for IAD.

A. Preoccupation with having a serious illness

B. Somatic Symptoms or not present or very mild.  Other symptoms related to a different disorder are ignored.

C. High level of anxiety about health

D. The individual performs excessive health related behaviors for checkups

E. Illness preoccupation exceeds 6 months

F. The illness preoccupation has no other mental health disorder explanation

The DSM-V-TR specifies them as either care seeking or care avoidant

Ultimately within all of these disorders, individuals refuse to believe experts and fall more so upon their own anxiety ridden logics.  They tend to seek their own information and insist they know more than medical professionals.

Tied closely to this are other disorders resulting in faking symptoms or purposely re-creating the symptoms for medical help or attention.  Some do this for mental reasons, while others seek financial reward via malingering.  Obviously those who seek medical attention and cause symptoms for no logical or financial reason suffer a deeper issue.   Factitious Disorder results in this deception to gain attention or aid.  Some may also look to keep attention on a person under one’s care by causing or lying about symptoms.   In the past this was referred to as Munchausen Syndrome (Barlow, et al., 2023).

It is interesting to see the power of the mind to cause physiological symptoms.  Yet if one simply realizes the power of worry to cause a stomach ache, then one can see on a large scale how somatic symptoms can manifest in individuals with greater anxiety and distorted beliefs about health.

Dissociative Disorders

Dissociative Amnesia can be general or selective

While the mind can create physiological symptoms, it can also create separations from reality due to traumatic events or high levels of stress.  Many of the dissociative disorders are closely tied to PTSD and trauma induced orders and directly follow the DSM-V-TR’s chapter on Trauma and Stress Related Disorders.  The DSM-V-TR points out that many dissociative disorders are frequently in the aftermath of severe trauma.  Their symptoms include “unbidden intrusions into awareness and behavior, with accompanying losses of continuity in subjective experiences (2022).  This leads to depersonalization, derealization, amnesia and dissociative identity.  They can all play roles in the more general umbrella of PTSD but also be a diagnosis within itself.

Depersonalization/Derealization Disorder

According to the DSM-V-TR, depersonalization is the experience of unreality, detachment or being outside or external from one’s own thoughts, or feelings or even sensations of the body.  One senses a distorted senses of time and feels absent from self as if almost outside of one’s own body (2022).  Similar and also shared frequently between the two is the subjective experience of derealization.  Within derealization one experiences unreality and detachment from one’s surroundings as if reality is dreamlike or foggy or distorted (2022).

Dissociative Amnesia

Loss of memory due to trauma leaves the person with an inability to recall or remember.  The loss of memory can be localized or selective only to the event, or in more severe cases generalized and effecting one’s identity (DSM-V-TR, 2022).   In some cases, it can be specified with dissociative fugue where the individual travels or wanders and cannot relate where they came from (2022).

Dissociative Identity

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is a trauma reaction usually formed in early childhood after a traumatic event

One of the most wild and bizarre forms of dissociation is multiple personalities.  The DSM-V-TR now labels it as Dissociative Identity in which the person creates different identities when faced with intense trauma.  These identities are formed at a younger age and usually add new ones as the person needs to adjust to the unresolved trauma.  The DSM-V-TR lists the following criteria for diagnosis

A. Disruption of identity by two or more distinct personality states.  The disruption marks a distinct discontinuity in sense of self which displays changes in behavior, memory, perception, consciousness, cognition and sensory-motor functioning.

B. Recurrent gaps to recall events and personal information are inconsistent with normal forgetfulness

C. The symptoms cause significant distress to all elements of social functioning

D. The disturbance is not part of a cultural or religious practice

E. The disturbance is not associated with other substances or medical conditions

(DSM-V-TR, 2022).

Barlow states that most experience an average of 15 different personalities or alters.  These alters merge from the host identity (2023).   It is believed that under severe cases of trauma, younger children who may possess a genetic and biological vulnerability can develop DID.  Diagnosing DID should be done with great care as not to lead an individual to bias or place falsememories regarding a person’s past.  Ultimately, it is very difficult to fake DID although criminals in the past have attempted to use a DID defense (Barlow, et, al. 2023).

Some identities are classified as possessive identities which can be mistaken for demonic manifestation.  If existing within the religious traditions, one must be careful of cultural and religious beliefs regarding this.  In fact, the Catholic Church goes to great lengths and diagnosis within itself to determine a difference between a possessing identity with what it considers to be an external source in its manual of exorcism.   Obviously before the era of modern science, many DID were considered possessions and did not meet the current diagnosis within the Catholic Church.  Those who are not religious still doubt any form of possession within itself but that is a debate for another day.

Conclusion

Please also review AIHCP’s Healthcare Certifications as well as its Trauma Informed Care program

Physiological symptoms can be very real.  The brain can shut itself off for its own defense and create different realities.  These are all things that modern psychology has discovered.  Many of these issues stem from trauma, anxiety and stress.  When a person has the biological vulnerability, the recipe for the manifestation for these disorders become a reality for the person.  Therapy and medication can play large roles in facing past issues and traumas.  With the exception of DID, many of these mental issues can resolve quickly with proper care.  Obviously DID deals with a far deeper trauma and requires deeper psychotherapy to unify the person.  That involves identifying triggers, reliving trauma, and carefully realigning the past without causing more damage (Barlow, et al., 2023).

Please also review AIHCP’s Behavioral Health Certifications.  AIHCP offers Trauma Informed Care as well for professionals seeking additional training and credentials in this field.

Additional Blogs

Disruptive and Impulse Control Disorders.  Access here

Personality Disorders.  Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th  ed.). Cengage Learning

Additional Resources

Goodman, B. 2024. “Somatic Symptom and Related Disorders”. WEBMED.  Access here

“What is Somatic Symptom Disorder?” APA.  Access here

“Dissociative Identity Disorder (Multiple Personality Disorder)” (2024). Cleveland Clinic.  Access here

“Dissociative Identity Disorder (Multiple Personality Disorder)”. PsychologyToday.  Access here