The 3 D’s Third Rail of the 4’th

This was written for PSYCH-333 Abnormal Psychology for Washington State University as a response to the following prompt.

What are the 3 D’s used to define abnormal behavior? What additional “D” is also used in defining behavior? Why is this 4th “D” considered controversial?

The answer is covered in the introduction to just before the conclusion. A conclusion is offered as it is an emanation of the literature review so prompted by this course. Thank you for any and all commentary.


The 3 D’s used to define abnormal behavior are dysfunction, distress, and deviance. I think it might be beneficial to consider that these are operationalizing definitions, and very useful in basic and applied sciences. Each one of the elements of the 3 D’s are conceptually dense, and through this density offer a rich schema to accelerate studying and working with a variety of psychological phenomena for the betterment of society (caution, see below). The three D’s will be covered along with an additional D, then follow with a conclusion that might highlight a potential glaring bias in the definitions, which is most likely a matter of ethnocentric artifact rather than a matter of imperialist intent.


The first, dysfunction, as defined in DSM-5 relies on an operational definition and understanding of “clinically significant“, “disturbance“, “cognition, emotion regulation… behavior“, “reflects“, and “psychological, biological… developmental processes” (American Psychiatric Association, 2013, p. 20). Therefore one could reasonably understand that “clinically” is a setting within which “significance” is measured by diagnostics (i.e., psychometrics, neural networks [i.e., humans, artificial]), hence the inclusion of the word “diagnostic and statistical” in the title of DSM-5 (p. 20). “Cognition, emotional regulation, or behavior” seems to cover that which is measured across the dimensions of “psychological, biological… [and] developmental processes” (p. 20). The final words remaining are “disturbance” and “reflects“, and herein is where dysfunction carries weight of cultural norms of expected species function, hence DSM-5’s clear inclusion of cultural issues in advance of these definition (pp. 14-15).

The second, distress, moves away from the reference frame of an individual’s function and more holistically to individual-social interaction, where “social, occupational, or other important activities” (p. 20) hones in on the two key words, “important” and “activity” (p. 20). Again a cultural reference frame applies, as importance receives cultural emphasis, biasing toward “activity”. It is important to note that “psychological or physical pain” is key here (Bridley & Daffin, 2020, p. 1-8), which seems to imply that “important” may be more than just cultural, as it is also inclusive of what is important to the individual themselves (i.e., “other important activities” [p. 20]), where the importance is a gestalt of conditioning, classical, operant, and social modeling, and altered by physiological changes.

The third, deviance, appears to strike straight at “clinically significant” departures from norms (i.e., means and standard deviations) of both individual expected species function (dysfunction) and individual expected environmental experience (i.e., pain [deflection]) in “social, occupational, or other important activities” (p.20). It is important to note that norms change, and are in part changed as a result of social deviancy (Witt, 2018, pp. 132-134).


The additional D is summarized as dangerousness. At the tension between control and conformity (Witt, 2018, pp. 128-131) and deviance, comes tension, and where this tension may result in perceptions of threat to norms (i.e., pathological behavior, protest, radicalization etc.). It is interesting that the etymology of danger is “arrogance, insolence” and has its roots on “power of a lord” (Online Etymology Dictionary, 2021), for it does indeed strike at one who is able to swiftly dictate and move norms. At this tension lies law and order, and it is here that mental health professionals are legally obligated to engage if a threat to harm another or themselves is predicted (Bridley & Daffin, 2020, p. 1-9).  There is controversy here, as Milgram’s (1963) experiments on obedience, subsequent ethically constrained replication demonstrating the same (Burger, 2009), and overall civil rights, and equality movements suggest. Thankfully dangerousness “is more than an exception than a rule” (Bridley & Daffin, 2020; Hiday & Burns, 2009).


Regarding the three D’s and the tight integration of culture and socio-economic conditions constraining statistical sampling in generalizing norms, it is clear that the fourth D is rife with much controversy. For example, men have been largely used for early establishing research predicating norms of psychological behavior, and now society’s business world is a veritable echo chamber of an over-prescription of “fight or flight” armchair treatment modalities, yet there is statistical significance of another stress response “tend and befriend” that was not visible due to the nature of bias in sampling (Taylor, Gruenewald, Gurung, & Updegraff, 2000). The needle of danger may be read by different groups different ways, for what is arrogant to one may be courage to another (i.e., slave emancipation, women’s suffrage, Black Lives Matter, Occupy Wall Street). Thankfully university settings seem to guard a healthy deviancy within which fields advance, yet again, what is healthy to one may not be healthy to another.

Upon review, I think there is a core bias lurking within which said controversy emerges and that is this emphasis on “action” embedded so innocuously in the definition of distress. When stepping back, perhaps, and rightly so, it is most likely action itself that is stressing (i.e., friction, production, war), and there are degrees of stress (i.e., heat, global warming, climate change), yet where is the prefix dis- put upon it? Sitting attentively, listening wholly, to Carl Rogers work with clients, one may walk away noting that empathy does not carry, for carrying is an action, empathy simply does not, it purely does not act, it receives, fully, and open heartedly, and for some reason it appears that this lack of action is utterly therapeutic for a client. Why should psychologists be the only ones able to offer this lack of action as therapy, and gate keep it? Why should not the D’s include its lack as a dysfunction? Controversy upon controversy, the student doth protests establishment.

Why could not inaction be afforded to the masses in matters of social, occupational, or other [in-]activities? It therefore makes sense that perhaps there is strong neurotic bias in the three D’s and perhaps this bias itself might be what exacerbates the three D’s and leads to the fourth D. It is quite controversial, in the overwhelming tension favoring action over inaction leading to the subsequent perception of danger as a result (see Horney’s concepts of society’s increasing neuroticism). Rogers himself, and Skinner too, were and are still perceived by portions of society as dangerous (Dvorsky, 2014; Demanchick & Kirschenbaum, 2008). Even my own mother is hyper-avoidant of any and all psychologists, and now is cautionary with me in these studies. So please be careful with the three D’s, and that “third rail” of the fourth.


American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association.

Bridley, A., & Daffin, L. W. (2020). Abnormal Psychology. Pullman, WA: Washington State University.

Burger, J. M. (2009). Replicating Milgram: Would people still obey today? American Psychologist, 64(1), 1–11. (Links to an external site.)

Demanchick, S. P., & Kirschenbaum, H. (2008). Carl Rogers and the CIA. Journal of Humanistic Psychology, 48(1), 6–31. (Links to an external site.)

Dvorsky, G. (2014, March 21). Why B.F. Skinner may have been the most DANGEROUS Psychologist Ever. Gizmodo. (Links to an external site.).

Hiday, V., & Burns, P. (2009). Mental Illness and the Criminal Justice System. In T. Scheid & T. Brown (Eds.), A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems (pp. 478-498). Cambridge: Cambridge University Press. (Links to an external site.)

Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411–429. (Links to an external site.)

Milgram, S. (1963). Behavioral Study of obedience. The Journal of Abnormal and Social Psychology, 67(4), 371–378. (Links to an external site.)

Witt, Jon. 2018. SOC 2018. Fifth edition. New York, NY: McGraw-Hill Education.