Concept Creep: Psychology's Expanding Concepts of Harm and Pathology

Abstract

Many of psychology’s concepts have undergone semantic shifts in recent years. These conceptual changes follow a consistent trend. Concepts that refer to the negative aspects of human experience and behavior have expanded their meanings so that they now encompass a much broader range of phenomena than before. This expansion takes ‘horizontal’ and ‘vertical’ forms: concepts extend outward to capture qualitatively new phenomena and downward to capture quantitatively less extreme phenomena. The concepts of abuse, bullying, trauma, mental disorder, addiction, and prejudice are examined to illustrate these historical changes. In each case, the concept’s boundary has stretched and its meaning has dilated. A variety of explanations for this pattern of ‘concept creep’ are considered and its implications are explored. I contend that the expansion primarily reflects an ever-increasing sensitivity to harm, reflecting a liberal moral agenda. Its implications are ambivalent, however. Although conceptual change is inevitable and often well motivated, concept creep runs the risk of pathologizing everyday experience and encouraging a sense of virtuous but impotent victimhood.

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Psychological Inquiry
An International Journal for the Advancement of Psychological Theory
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Concept Creep: Psychology's Expanding Concepts
of Harm and Pathology
Nick Haslam
To cite this article: Nick Haslam (2016) Concept Creep: Psychology's Expanding Concepts of
Harm and Pathology, Psychological Inquiry, 27:1, 1-17
To link to this article: http://dx.doi.org/10.1080/1047840X.2016.1082418
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TARGET ARTICLE
Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology
Nick Haslam
Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
Many of psychology’s concepts have undergone semantic shifts in recent years.
These conceptual changes follow a consistent trend. Concepts that refer to the
negative aspects of human experience and behavior have expanded their meanings
so that they now encompass a much broader range of phenomena than before. This
expansion takes “horizontal” and “vertical” forms: concepts extend outward to
capture qualitatively new phenomena and downward to capture quantitatively less
extreme phenomena. The concepts of abuse, bullying, trauma, mental disorder,
addiction, and prejudice are examined to illustrate these historical changes. In
each case, the concept’s boundary has stretched and its meaning has dilated. A
variety of explanations for this pattern of “concept creep” are considered and its
implications are explored. I contend that the expansion primarily reflects an ever-
increasing sensitivity to harm, reflecting a liberal moral agenda. Its implications
are ambivalent, however. Although conceptual change is inevitable and often well
motivated, concept creep runs the risk of pathologizing everyday experience and
encouraging a sense of virtuous but impotent victimhood.
Key words: bullying, concepts, moral psychology, prejudice, trauma
Writing in 1993, Daniel Patrick Moynihan, senior
senator for New York, alliterated that his country was
“defining deviancy down.” Moynihan argued that in
response to rising crime and social disorder in the
1970s and 1980s, the public increasingly normalized
behavior that would once have been seen as patholog-
ical. Sometimes, he proposed, this process was driven
by the worthy goal of social inclusion, countering the
tendency to stigmatize people on society’s margins.
At other times it merely represented a habituation to
ongoing social change. Whatever its cause, phenom-
ena that had once been seen as deviant were redefined
as the new normal.
To Moynihan (1993), the social and political
implications of these developments were troubling.
By coming to accept crime and family breakdown, he
argued, people were “getting used to a lot of behavior
that is not good for us” (p. 30). Conservatives, he
wrote, are especially opposed to these normalizing
redefinitions of deviance because they see them as
weakening standards of conduct and loosening moral
strictures. Liberals, in contrast, are traditionally wary
of the opposite process, in which normal rebellion or
alternative ways of living are pathologized.
There is nothing inevitable about the progressive
expansion of normality that Moynihan documented.
Indeed, I argue that in recent decades the opposite pro-
cess has unfolded: The definition of some forms of devi-
ance has enlarged and normality has contracted.
Psychology has played a significant role in this process,
as many of the concepts it employs to make sense of
undesirable forms of experience and behavior have
extended their meanings, encroaching on phenomena
that would once have been seen as unremarkable. More-
over, although Moynihan argued that liberals resist
attempts to pathologize deviance, psychology’s expan-
sionary redefinition of negative phenomena arguably
reflects a liberal social agenda. Instead of defining devi-
ancy down, psychology has ubiquitized it up.
Conceptual Change
Conceptual shifts can be observed in public dis-
course, the focus of Moynihan’s attention. They can
also be seen in the discourse of the social and behav-
ioral sciences. These fields traffic in what the philoso-
pher Ian Hacking (1995) called “human kinds”:
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ISSN: 1047-840X print / 1532-7965 online
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“kinds of people, their behaviour, their condition,
kinds of action, kinds of temperament or tendency,
kinds of emotion, and kinds of experience”
(p. 351–352). According to Hacking, the meanings of
human kinds are not fixed. Unlike “natural kinds,”
such as biological species or chemical elements,
human kinds are moving targets. The changes that
they undergo may influence social reality rather than
merely mirroring it. Because human kinds form the
basis of social judgments and policies, they are sus-
ceptible to “looping effects.” How we define,
describe, and label a human kind can mould it by
influencing how the people so defined come to under-
stand themselves. Through analyses of emerging
kinds such as “child abuse,” “autism,” and “multiple
personality disorder,” Hacking (1991) showed how
people come to recognize themselves in professional
characterizations, and how they shape their behavior
and sense of self in response.
We should therefore expect psychological con-
cepts to undergo semantic changes, and for these
altered meanings to have looping effects on how peo-
ple make sense of themselves personally and collec-
tively. The conceptual changes that I explore in this
article involve alterations in the semantic “extension”
of the relevant concepts, that is, the range of phenom-
ena to which they apply. I propose that these altera-
tions take two forms. The first, which I dub “vertical
expansion,” occurs when a concept’s meaning
becomes less stringent, extending to quantitatively
milder variants of the phenomenon to which it origi-
nally referred. For example, a mental disorder has
undergone vertical expansion if its new diagnostic
criteria encompass less severe and debilitating clini-
cal phenomena than previous criteria. Vertical expan-
sion can occur through a lowering of the threshold for
identifying a phenomenon or through the relaxation
of criteria for defining it. The second form of concep-
tual change, which I call “horizontal expansion,”
occurs when a concept extends to a qualitatively new
class of phenomena or is applied in a new context.
For example, the concept of “refugee” has expanded
to include people displaced by environmental catas-
trophe, whereas it originally referred only to those
displaced by conflict.
Overview
The main contention of this article is that in recent
decades the meanings of several of psychology’s key
concepts have changed in a systematic way. I argue
that those changes have targeted particular kinds of
concept and moved in a particular direction. Specifi-
cally, it is psychology’s negative concepts—those
that refer to undesirable, harmful, or pathological
aspects of human experience and behavior—that had
meaning changes, and these changes have consis-
tently expanded those meanings. The concepts in
question continue to refer to the phenomena they
denoted at an earlier time, but they now also refer to
a horizontally and vertically enlarged range of addi-
tional phenomena. This semantic inflation is not
widely appreciated by psychologists. When it has
been noted it has been discussed in relation to a single
concept, and the general pattern has been missed. In
the body of the article I illustrate the “concept creep”
hypothesis by reviewing changes in six concepts
drawn from the provinces of developmental, clinical,
and social psychology: abuse, bullying, trauma, men-
tal disorder, addiction, and prejudice.
After presenting these six case studies, I examine
the causes and implications of the changes they illus-
trate. I argue that a good explanation of concept creep
must account for why the changes are specific to neg-
ative concepts and why they involve expansion rather
than contraction. It should also encompass both verti-
cal and horizontal expansion and account for the con-
sistency of the effect across diverse concepts rather
than explaining each change on its own terms.
Explanations that invoke technological, social, and
cultural developments are entertained, as are some
that implicate psychology as a discipline.
I then discuss the wider consequences of concept
creep. As Hacking argued, changes in human kind
concepts alter social reality, looping back into how
people understand themselves and one another and
bringing new kinds of people into existence through
what he called “dynamic nominalism” (Hacking,
1986). I am at pains not to present concept creep as
unambiguously desirable or undesirable, or to write it
off as arbitrary or unwarranted. Conceptual revision
is to be expected in view of changing scientific and
social realities, and it may be appropriately respon-
sive to those changes. Although many critics have
held psychological concepts responsible for damag-
ing cultural trends—such as supposed cultures of
fear, therapy, and victimhood—the conceptual shifts
I present have some positive implications. Neverthe-
less, they also have potentially damaging ramifica-
tions for society and for psychology that cannot be
ignored.
Case Study 1: Abuse
The concept of abuse has grown in prominence
within psychology and related fields, largely through
the growing awareness that maltreatment of children
and adults, and its implications for mental health, has
been underestimated in the past. This underestimation
goes back at least as far as Freud’s abandonment of
the seduction theory of hysteria. Decades of research
have established the disturbing high prevalence of
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sexual and physical abuse and demonstrated their
causal role in a variety of mental disorders.
Hacking (1991) has written at length about the
shifting understandings of abuse and the relevance of
looping effects to those shifts. He documented the
malleability of ideas of child abuse and how these
were shaped by cultural trends, legal institutions, and
social movements such as feminism and children’s
rights activism. However, his historical study primar-
ily addresses changes in professional and popular rep-
resentations of abuse from the 19th century through
to the 1970s and does not focus specifically on psy-
chology. My emphasis here is on more recent changes
in the definition of abuse within that field.
Classic psychological investigations of abuse rec-
ognized two forms, physical and sexual. Physical
abuse involved the intentional infliction of bodily
harm, whereas sexual abuse involved inappropriate
sexual contact, including penetrative sex or nonpene-
trative molestation. Childhood exposure to these
forms of abuse was found to increase vulnerability to
adult psychopathology, relationship difficulties, and
physical ill health.
Three changes to the conceptualization of abuse
that have occurred within the psychological literature
over recent decades represent clear cases of horizon-
tal expansion. First, “emotional abuse” (Thompson &
Kaplan, 1996)—sometimes labeled “psychological
abuse”—was introduced as a new abuse subtype. It
refers to forms of maltreatment that need not involve
bodily contact, unlike physical and sexual abuse, but
includes verbal aggression and other behavior that is
domineering, intimidating, threatening, rejecting,
degrading, possessive, inconsistent, or emotionally
unresponsive. This form of abuse was commonly
studied within intimate domestic relationships. This
new focus on behavior exchanged between adults
represents a second horizontal extension of the abuse
concept from its traditional focus on the behavior of
adults toward children.
A third horizontal extension of the abuse concept
is its incorporation of neglect. Neglect implies a lack
of appropriate care and concern, as when negligent
parents fail to tend to their children’s basic needs for
food, shelter, clothing, physical contact, and affec-
tion. In the early literature on child maltreatment,
neglect and abuse were traditionally considered sepa-
rately—the field’s flagship journal, which com-
menced publication in 1976, was entitled Child
Abuse and Neglect—but increasingly neglect has
been understood as a form of abuse. Cicchetti and
Barnett’s (1991) taxonomy of child abuse, for exam-
ple, considers physical neglect as one of its subtypes.
Similarly, Goldsmith and Freyd (2005) considered
emotional neglect, or “emotional unavailability,” to
be a form of emotional abuse.
Emotional abuse and neglect-as-abuse are ideas
that represent horizontal extensions of the abuse con-
cept. The former extends abuse into the realm of non-
physical harm, where damage is done indirectly
through language or social interaction. The latter
extends the abuse concept by including acts of omis-
sion. Whereas physical and sexual forms of abuse
represent the commission of undesirable acts toward
a victim, neglect involves the failure to commit desir-
able acts. Neglect, like physical or sexual abuse, can
be an act in the sense of being deliberate, but it differs
from these prototypes of abuse by referring to
inaction.
The inclusion of emotional abuse and neglect
within a broadened concept of abuse may also repre-
sent a vertical expansion of that concept. Emotional
abuse encompasses some forms of interpersonal mal-
treatment that are more diffuse and ambiguous than
those that fall within the realms of physical and
sexual abuse, which, because they require bodily con-
tact, are intrinsically more tangible. Determining
what counts as emotional abuse may have a larger
element of subjectivity. Whether a particular interac-
tion represents humiliation or teasing, possessiveness
or protectiveness, and aggressiveness or assertiveness
may be uncertain and the parties involved may have
very different perceptions. If deciding whether emo-
tional abuse has occurred depends on the self-identi-
fied victim’s perception, abuse can be invoked as a
description that might seem innocuous from an inde-
pendent observer’s standpoint. This reliance on
highly subjective impressions is a feature of some
methods of assessing abuse, as in the following item
from a popular self-report measure: “As a child, did
you feel unwanted or emotionally neglected?”
A similar vertical expansion of the abuse concept
can result when it incorporates neglect. Because crite-
ria for judging omissions (i.e., what was not done that
should have been) tend to be less concrete than those
for judging commissions (i.e., what was done that
should not have been), the boundary of neglect is
indistinct. As a consequence, the concept of neglect
can become overinclusive, identifying behavior as
negligent that is substantially milder or more subtle
than other forms of abuse. This is not to deny that
some forms of neglect are profoundly damaging,
merely to argue that the concept’s boundaries are suf-
ficiently vague and elastic to encompass forms that
are not severe.
This brief discussion of abuse reveals that the con-
cept’s meaning has undergone significant inflation,
horizontal and vertical. Its message is well captured
by Furedi (2006), who noted a “continuous expansion
of the range of human experiences which can be
labelled as abusive,” such that “neglect and unin-
tended insult become equated with physical violence
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and incorporated into an all-purpose generic category
” (p. 86).
Case Study 2: Bullying
Abuse originally referred to objectionable and
damaging behavior directed toward children by
adults. Bullying also refers to destructive behavior,
but it has been primarily examined in the contexts
where children are both victims and perpetrators.
Understood as a form of proactive aggression, bully-
ing has been the focus of an explosion of research
since the concept emerged in Scandinavia in the
1970s. As Olweus (2013) has observed, citations of
bullying research increased 100-fold from 1990 to
2010.
Olweus, the father of bullying research, proposed
three core elements that define the phenomenon: aggres-
sive or otherwise negative actions that are directed
toward a child by one or more other people, where that
behavior is intentional, repetitive, and carried out in the
context of a power imbalance. The victim has less
power—whether in numbers, size, strength, age, status,
or authority—than the bully. Bullying is therefore con-
ceptually distinct from peer aggression, where the
aggression may not be repeated and the combatants
maybeofmoreorlessequalpower.
The behavior that constitutes bullying takes a vari-
ety of forms. Prototypically it involves direct physical
harassment, including hitting, kicking, coercion and
intimidation, and verbal harassment, including racial
and sexual comments, unfriendly teasing, name-call-
ing, and threats. Bullying also incorporates indirect
or relational behaviors that involve third parties, such
as spreading rumors, manipulating friendship net-
works, and deliberately excluding or isolating the bul-
lied child from joint activities.
The primary conceptual expansion of “bullying”
has been horizontal. One extension that has attracted
great media attention is “cyber-bullying,” understood
as bullying behavior conducted using the Internet or
mobile technologies (e.g., making threats, spreading
rumors, posting offensive images). Although some of
the online behaviors that qualify as cyber-bullying
closely resemble traditional verbal bullying, con-
ducted through a new medium, others are distinctive.
Although surveys indicate that cyber-bullying may
not be as common as “traditional” bullying, and that
relatively few children who have been cyber-bullied
have not also been bullied traditionally, it never-
theless represents a new class of behaviors that
stretch the concept of bullying beyond its earlier
meaning.
An even more striking horizontal extension of the
bullying concept is its growing application to adult
workplaces (e.g., Salin, 2003). Bullying is now
researched and studied in organizational contexts
almost as much as in schoolyards. According to the
Web of Science database, 12.7% of the articles men-
tioning bullying published in the 1990s were in devel-
opmental psychology journals, holding relatively
constant at 14.0% in the 2000s, and 13.3% in the
2010s. Across these decades the share of articles pub-
lished in occupational and organizational psychology
journals rose from an insignificant 1.3% to 8.8% and
then 10.8%.
Bullying in workplaces resembles school bullying
at least superficially, and the same elements of physi-
cal, verbal, and indirect or relational bullying may
occur, although physical intimidation is probably less
frequent and verbal harassment more subtle than
playground name-calling. However, even if analo-
gous behavior occurs in the two settings, a horizontal
concept extension has occurred because phenomena
that would once have been conceptualized as some-
thing other than bullying (e.g., repeated public denun-
ciations of employees by supervisors) now fall under
its umbrella.
A third form of horizontal creep of the bullying
concept involves types of behavior rather than
medium or setting. Although early definitions
emphasized direct physical and verbal forms of
school bullying, current definitions include behav-
iors that are not directed at the bullied child but
operate by manipulating relationships with other
people. These behaviors include ignoring and
excluding children. As Mishna (2012) noted, “It is
only fairly recently that indirect and social exclu-
sionary forms of peer victimization were labelled as
bullying” (p. 41). For instance, one early bullying
scale (Neary & Joseph, 1994) omitted indirect forms
entirely, referring only to physical (hit and pushed,
picked on, and bullied) and verbal (teasing, name-
calling, being laughed at) actions. Olweus’s (1989)
description of bullying in the original Olweus Bully-
ing Questionnaire mentioned a single exclusionary
behavior (“a kid is being bullied ... when no one
ever talks to them”) among a large number of physi-
cal and verbal behaviors. The recent extension of
the bullying concept to give greater attention to
exclusion is also evident in definitions of workplace
bullying, one checklist giving as an example times
when someone “gave you the silent treatment” (Fox
& Stallworth, 2005)
The horizontal creep of the bullying concept into
electronic media and adult workplaces, and into
indirect and exclusionary actions, is striking. How-
ever, the concept has also undergone some vertical
expansion such that milder or less extreme phenom-
ena have come to count as bullying. One form of
vertical creep is a relaxation of the repetitiveness
criterion in the definition of bullying. To some
extent this loosening has been prompted by the
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advent of cyber-bullying, in which posting a single
offensive picture or message may be considered to
constitute bullying. However the same relaxation
has occurred in the traditional bullying domain as
well. The original Olweus Bullying Questionnaire,
for example, specified in its instructions to children
that “when we talk about bullying, these things hap-
pen repeatedly,” but the revised version stated that
“these things may happen repeatedly” or “are
usually repeated” [emphasis added].
A similar loosening of the definition of bullying
can be observed with the power imbalance criterion.
Olweus has insisted that this defining element is vital
for distinguishing bullying from general peer aggres-
sion, but it has been difficult to nail it down. Tradi-
tionally power imbalance was understood primarily
in terms of size, age, or number, as when one child
was victimized by a group, all of these factors making
it difficult for victims to defend themselves. More
recent understandings consider power imbalance in
terms of differential peer-group status, popularity,
and even self-confidence (Olweus, 2013), none of
which transparently implicate “power” as it is usually
understood.
The horizontal creep of bullying into cyberspace
and workplaces makes the retention of a restricted
view of power imbalance even more difficult. Smith,
del Barrio, and Tokunaga (2012) note that in cyber-
bullying, where the bully may be anonymous and
therefore of unknown relative to the victim, power
imbalance can be understood in terms of differences
in “technological know-how between perpetrator and
victim, relative anonymity, social status, number of
friends, or marginalized group position” (p. 36).
Other difficulties in restricting the meaning of power
imbalance arise in organizations, where power differ-
entials based on rank are officially legitimated, unlike
schoolyards. The person who is accused of bullying
for repeatedly criticizing a subordinate’s work may
have formal responsibility for the management of
that employee’s performance so that the power imbal-
ance is intrinsic to the relationship and to the behavior
itself. In addition, definitions of workplace bullying
allow for bullies being same-rank coworkers.
A third form of vertical creep can be seen in the
relaxation of the intentionality criterion in workplace
bullying research. As Salin (2003) observed, “intent
is typically not part of the definition, but instead the
subjective perception of the victim is stressed” (p.
1215–1216). Thus bullying can be said to occur even
if the identified bully had no intent to harm the identi-
fied victim. This broadens the traditional concept of
bullying by including behavior that might be
inadvertent.
This opening of the definition of bullying to the
subjectivity of victims arguably represents a fourth
form of vertical creep and is also observed in school
bullying scholarship. Olweus (2013), for example,
proposed that “the ultimate” power of definition
“must reside with the targeted student” (p. 757) as to
when a power imbalance occurs. Similarly, Mishna
(2012) argued forcefully that victims’ judgments of
whether they have been bullied should take prece-
dence over those of perpetrators and adult observers,
such as parents and teachers. (This principle sits
uneasily with Mishna’s acknowledgment that chil-
dren may not identify their mistreatment as bullying
and may have to be educated into accepting the
label.) Thus, if a child perceives social exclusion to
have been deliberate, repeated, and hurtful, or “jokes”
to have been said with malice rather than jest, then
bullying has occurred. In the workplace, similarly, it
is victims’ “perceived” power imbalance that is taken
as relevant to the definition of bullying and their per-
spective may be privileged in deciding what counts
as bullying. One measure of experiences of “general
bullying behavior” lists a variety of ambiguous
behaviors: a person “limited your ability to express
an opinion,” “gave excessively harsh criticism of
your performance,” “made unreasonable work
demands,” and “applied rules and punishments incon-
sistently” (Fox & Stallworth, 2005). The inclusion of
behaviors such as these within the concept of work-
place bullying is pungently criticized by Furedi
(2006). Considering an organization’s report on its
members’ concerns about the phenomenon, he wrote:
“It became clear that what MSF categorizes as bully-
ing in the workplace is what used to be called office
politics” (p. 87).
To summarize, the concept of bullying has spread
from its original meaning to encompass a wider range
of phenomena. It has expanded horizontally into
online behavior, into adult workplaces, and into
forms of social exclusion that do not directly target
the victim with hurtful actions, as distinct from hurt-
ful omissions. It has also expanded vertically so that
behavior that is less extreme than prototypical bully-
ing now falls within its bounds, primarily by loosen-
ing defining criteria. In some circumstances bullying
behavior need not be repeated or intentional, and it
need not occur in the context of a power imbalance as
traditionally conceived. Greater weight in determin-
ing when bullying has occurred is now given to the
subjective perceptions of the victim. As a result,
“bullying” can now refer to a much greater variety of
actions than it did originally.
As Cascardi, Brown, Iannarone, and Cardona
(2014) recently observed, the broadening definition
of bullying has significant practical consequences.
They argued that the relaxation of the original
requirement that behavior must occur in a power
imbalance and be repeated has eroded distinctions
between bullying, on one hand, and harassment and
peer aggression, on the other. Cascardi et al. noted
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that the expanded definition of bullying is now
inscribed in U.S. state antibullying statutes and can
have troubling implications for free speech rights and
for schools that could “be required to report and
investigate every aggressive transgression, from play-
ground teasing and roughhousing to aggravated
assault” (p. 255). Equally, they argued, blurred
boundaries between bullying, harassment, and peer
aggression can lead to inappropriate interventions, as
these forms of aggression typically require different
therapeutic and legal responses.
Case Study 3: Trauma
Trauma, from the Greek for “wound,” originally
referred to a morbid condition of the body produced
by a physical insult. Its cause was an external event,
and its effect was an organic disturbance that might
manifest in psychological symptoms. This meaning
was operative in the first edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-I;
American Psychiatric Association [APA], 1952),
which described a class of “chronic brain disorders
associated with trauma,” including disorders caused
by “brain trauma, gross force” and “electrical brain
trauma.” Related classes of chronic brain disorders
were associated with infections, poisoning, and con-
genital conditions. A trauma was therefore seen
within mid-20th-century psychiatry as a physical
agent causing organic brain pathology.
Trauma now refers to a much broader set of phe-
nomena, although the earlier meaning persists within
it, as in “traumatic brain injury.” DSM-III (APA,
1980) was a turning point, recognizing “post-trau-
matic stress disorder” (PTSD) as a mental disorder
for the first time. According to the manual, PTSD
was a distinctive cluster of symptoms linked causally
to a traumatic event. However, in contrast to the
DSM-I understanding of trauma, these symptoms
were not understood to spring from an organic injury
to the brain but from a psychological injury to the
mind, caused not by a physical insult but by a dis-
tressing experience. This is a classic example of hori-
zontal creep.
Although trauma can now refer not only to an event
that causes a wound (physical or psychic) but also to
the psychological symptoms that result, I focus on the
former meaning. Defining what counts as a traumatic
event has been an enduring source of controversy in
trauma studies. Disagreement is almost inevitable
because “there is a continuum of stressor severity and
there are no crisp boundaries demarcating ordinary
stressors from traumatic stressors” (Weathers & Keane,
2007, p. 108), and because people’s differing percep-
tions of an event’s seriousness may determine whether
it traumatizes them.
The working definition of “traumatic event” is
embodied in Criterion A of the DSM’s diagnostic
rules for PTSD (Long & Elhai, 2009). In DSM-III
(APA, 1980), Criterion A required that a traumatic
event “would evoke significant symptoms of distress
in almost everyone” (p. 238) and be “outside the
range of usual human experience” (p. 238). It stated
that “such common experiences as simple bereave-
ment, chronic illness, business losses, or marital con-
flict” (p. 247) generally fail to meet this requirement,
and listed rape, assault, military combat, natural dis-
asters, car accidents, and torture as events that gener-
ally succeeded. DSM-III-R (APA, 1987) retained the
key elements of this criterion but specified the nature
of the distress evoked by the traumatic stressor
(“intense fear, terror, and helplessness”; p. 250) and
of the threat that the stressor represented. In particu-
lar, it noted that this threat could be to one’s kin or
friends rather than oneself, that it could involve learn-
ing about an event that had afflicted them, and that
witnessing serious injury or death in another person
could also count as a traumatic event. DSM-III-R
therefore expanded the definition of trauma to include
indirect exposures. DSM-IV (APA, 1994) continued
to include indirect exposures as potential traumatic
events—it lists as one example learning about the
diagnosis of a life-threatening illness in one’s child—
and increased the emphasis on the subjectivity of the
traumatic stressor by introducing a new criterion con-
cerning the distress experienced in response to the
stressor.
Although the revisions of Criterion A from DSM-
III to DSM-IV seem relatively subtle, they have been
criticized for broadening the definition of trauma and
described as “conceptual bracket creep” by one critic
(McNally, 2004). In particular, the opening up of
indirect experiences as traumas represents an enlarge-
ment of the original concept. A study by Breslau and
Kessler (2001) found that only 14 of 19 experiences
that would qualify as potentially traumatic by
DSM-IV’s Criterion A1 would have met Criterion A
in DSM-III-R, all of the remainder representing indi-
rect exposures. The later version of Criterion A led to
a 22% increase in the number of traumatic events to
which their sample had been exposed. Weathers and
Keane (2007) also argued that DSM-IV’s listing of
“developmentally inappropriate sexual experiences”
as potential traumatic events represents a break with
the earlier understanding that traumas must involve
threats of serious injury or death.
This trend toward including indirect and noncata-
strophic events within the definition of trauma—which
has been partially arrested by DSM-5 (Zoellner,
Bedard-Gilligan, Jun, Marks, & Garcia, 2013)—exem-
plifies vertical expansion. It has led to an enlargement
of the range of events that are recognized as potential
triggers of PTSD. In recent years, trauma theorists and
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practitioners have proposed including childbirth, sexual
harassment, infidelity, and emotional losses such as
abandonment by a spouse or loss or a sudden move or
loss of home within that range. These extensions are
sometimes justified empirically by research showing
that these events can precipitate PTSD symptoms (e.g.,
Carlson, Smith, & Dalenberg, 2013). Nevertheless,
they represent a lowering of the threshold of severity
for traumatic events.
A recent definition of trauma produced by the U.S.
Government’s Substance Abuse and Mental Health
Services Administration exemplifies this lowering:
Individual trauma results from an event, series of
events, or set of circumstances that is experienced by
an individual as physically or emotionally harmful or
threatening and that has lasting adverse effects on
the individual’s functioning and physical, social,
emotional, or spiritual well-being.
This definition abandons most of the restrictive ele-
ments of DSM’s Criterion A. A traumatic event need
not be a discrete event, need not involve serious threats
to life or limb, need not be outside normal experience,
need not be likely to create marked distress in almost
everyone, and need not even produce marked distress
in the traumatized person, who must merely experi-
ence it as “harmful.” Under this definition the concept
of trauma is rendered much broader and more subjec-
tive than it was even three decades ago.
Case Study 4: Mental Disorder
The proliferation of mental disorders in successive
editions of the DSM is well known. The DSM’s pre-
cursor, War Department Technical Bulletin “Medical
203,” published in 1943, listed 47 conditions, a num-
ber that more than doubled to 106 diagnoses in DSM-
I(APA, 1952), leapt to 182 in DSM-II (APA, 1968),
jumped to 265 in DSM-III (APA, 1980), and then
hopped to more than 300 in the revised edition of the
DSM-IV (DSM-IV-TR; APA, 2000). The swelling
population of mental disorders has led critics of psy-
chiatry to accuse DSM of disease-mongering.
DSM’s expanding cast of mental disorders need
not reveal an expansion in the concept of “mental dis-
order.” DSM-IV-TR might map the same psychopath-
ological territory as DSM-I but in a more fine-
grained, high-resolution manner. Later editions of
DSM might merely split conditions recognized in ear-
lier conditions into narrower variants rather than
expanding into new territory as horizontal creep
would require. However, a comparison of the earliest
and more recent editions of DSM demonstrates that
successive DSMs not only subdivide existing disor-
ders but also open up new psychiatric terrain.
DSM-I contained seven groupings of mental disor-
ders: acute and chronic brain disorders, mental defi-
ciency, psychotic disorders, psychophysiologic
disorders, psychoneurotic disorders, personality dis-
orders (which included addiction), and transient situa-
tional personality disorders. DSM-II expanded the
range of psychiatric conditions in three ways. First, it
introduced a new “special symptoms” grouping that
included problems with sleep and eating, domains
that were not covered in the earlier edition. Second, it
extended the range of conditions afflicting young
people beyond DSM-I’s “mental deficiency” cate-
gory, recognizing a new grouping of behavior disor-
ders of childhood and adolescence. Third, it added
sexual deviations to DSM-I’s list of personality
disorders.
DSM-III divided up several of DSM-II’s disorder
groupings: It carved off substance-related disorders
and sexual disorders from personality disorders, split
the special symptoms grouping into separate eating
and sleep disorder categories, and cleaved psycho-
neurotic conditions into separate anxiety and mood
disorder groups. However, in addition to these divi-
sions of existing disorder groupings, DSM-III also
pushed back the psychiatric frontier by recognizing
new kinds of disorder in a clear demonstration of hor-
izontal creep. New groupings of factitious, impulse-
control, and dissociative disorders were defined, none
of their conditions corresponding in a straightforward
way to those described in previous DSM editions.
Further horizontal expansion can be seen in DSM-
III’s acquisition of new conditions within groupings
recognized in DSM-II. Disorders involving cognitive
difficulties were added to the disorders first diagnosed
in childhood and adolescence, sexual disorders were
expanded to include gender identity disorder (a con-
dition of gender, not sexuality), anxiety disorders
incorporated social fears and extreme shyness for the
first time (“social phobia”; see Lane, 2008), and sub-
stance-related disorders expanded to include prob-
lematic usage (substance abuse) that fell short of
addiction or dependence.
As a result of this consistent pattern of diagnostic
spread, many people whose clinical presentation
would not have warranted a DSM-I diagnosis—alco-
hol abusers, insomniacs, bulimics, Touretters, gender
dysphorics, anorgasmic women, dyslexic children,
and shy adults—would have received a DSM-III diag-
nosis. DSM-IV and DSM-5 have introduced further
horizontal creep, which is not reviewed here. The key
point is that successive editions of the manual have
progressively dilated the ostensive definition of men-
tal disorder. Although the prototypical psychiatric
conditions are continuously represented in some fash-
ion from DSM-I through DSM-5, new domains of
psychopathology have been added. Phenomena that
might previously have been understood as moral
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failings (e.g., substance abuse) bad habits (e.g., eating
problems), personal weaknesses (e.g., sexual dys-
functions), medical problems (e.g., sleep disturban-
ces), character foibles (e.g., shyness), or ordinary
vicissitudes of childhood now find shelter under the
umbrella concept of mental disorder.
The expanding register of mental disorders indi-
cates horizontal creep, but the concept of mental dis-
order has also undergone vertical creep. Recent
editions of DSM sometimes loosen the criteria for
determining where normality ends and mental disor-
der begins. This quantitative easing allows milder,
less disabling psychological phenomena to qualify as
disordered. Sometimes this relaxation of criteria takes
the form of recognizing less severe “spectrum” condi-
tions, as with cyclothymia, a less impairing variant of
bipolar disorder, and Asperger’s syndrome, a less
impairing variant of autistic disorder, which has
recently been reincorporated in the latter diagnosis,
thereby vertically expanding it.
Especially powerful cases for such a lowering of
diagnostic thresholds have been made by Horwitz
and Wakefield (2007, 2012) in their historical studies
of depression and anxiety disorders. They argued that
recent ways of diagnosing these conditions systemati-
cally misdiagnose normal affective responses as
forms of psychopathology. For example, symptom-
based diagnosis of depression conflates contextually
justified sadness with melancholia, the more restric-
tive traditional understanding of depression as
“sadness without cause,” resulting in a recent explo-
sion of diagnosed depression (Shorter, 2013). By mis-
representing normal sadness, worry, and fear as
mental disorders, the mental health professions over-
medicate, exaggerate the population prevalence of
disorder, and deflect resources away from more
severe conditions.
Much of the recent controversy surrounding
DSM-5 (2013) concerns this vertical creep and the
attendant risks of overdiagnosis and inappropriate
treatment. It prompted the architect of DSM-IV,
Allen Frances, to launch a crusade to “save normal-
ity” from the new edition (Frances, 2013). Several
of the targets of his campaign were clear examples
of relaxed diagnostic rules or new diagnoses with
less stringent criteria than those they replaced. The
removal of the bereavement exclusion for major
depression, which allowed grieving people to
receive a diagnosis of depression within 2 months
of the death when in the previous edition they
could not, is one example (Wakefield, Schmitz,
First, & Horwitz, 2007). Others are the relaxation
of rules for diagnosing attention deficit hyperactiv-
ity disorder among adults; the listing of a new
“somatic symptom disorder” for people who had
unusually strong worries about physical symptoms
that fell well short of previous diagnostic criteria
for hypochondriasis; and the advent of “mild neuro-
cognitive disorder,” a sort of “dementia lite.”
In sum, the evolving concept of mental disorder
has not only proliferated conditions but also
expanded sideways into new forms of psychopathol-
ogy and downward into milder forms. As a result, the
proportion of humanity warranting a diagnosis has
risen and the proportion of human experience and
behavior that counts as disordered has swelled.
Case Study 5: Addiction
Addiction can be considered under the rubric of
mental disorder, but it warrants its own discussion, in
part because the concept does not feature in many
classifications or disorder. The meaning of that con-
cept within psychology, psychiatry, and general med-
icine in the first half of the 20th century involved
physiological dependence on an ingested psychoac-
tive substance. The pharmacological properties of the
substance lead the addicted person to require progres-
sively more of it to attain the desired state (tolerance)
and cause the person to experience an unpleasant
physiological state when deprived of it (withdrawal).
This dependency creates an increasingly joyless pat-
tern of compulsive consumption. The classic addic-
tive drugs—alcohol, cocaine, heroin, nicotine—all
have properties that interact with the human body’s
motivational apparatus to generate these effects.
In recent decades the concept of addiction has
been enlarged by the identification of addictions that
do not involve substances. So-called “behavioral” or
“process” addictions to the Internet and gambling
have been proposed in the mental health literatures
(e.g., Potenza, 2006). For the first time compulsive
gambling (“gambling disorder”) has been officially
recognized within a class of “substance-related and
addictive disorders” in DSM-5 (APA, 2013), having
previously resided in a DSM-IV’s grouping of
“impulse control disorders.” DSM-5’s developers
entertained the idea of including a wider assortment
of behavioral addictions, and popular and academic
writers have provided many to choose from, propos-
ing behavioral addictions to sex, pornography, shop-
ping, online gaming, food, chocolate, exercise, social
media, TV, work, and tanning, among other things.
The recognition of behavioral addictions reflects in
part a growing acknowledgment among scientists that
certain compulsive behaviors overlap substantially with
substance addictions in their phenomenology, neurobiol-
ogy, natural history, personality correlates, and response
to treatment (Grant, Potenza, Weinstein, & Gorelick,
2010). Like substance addictions, behavioral addictions
involve recurrent failure to resist urges to engage in a
particular activity that is harmful to the person, generally
with a subjective experience of compulsion and
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powerlessness. They may involve withdrawal—and tol-
erance-like experiences and repeated unsuccessful
attempts to quit. In view of these similarities, it has been
argued that what matters for addiction is not the mani-
fest substance or behavior but the underlying process
whereby an activity that can provide gratification and
escape from discomfort becomes something over which
the person loses control and continues despite negative
consequences (Goodman, 1991). If the addictive process
is internal, it makes little sense to restrict the concept of
addiction to dependence on substances.
In addition to expanding horizontally to include
behavioral addictions alongside the earlier substance
addictions, recent developments in psychology have
also opened the concept to milder, less extreme forms
of compulsive behavior. This vertical expansion
is illustrated well by the concept of “soft” addictions
(Wright, 2006), which represent persistent activities
that carry some cost in money, time, energy, or inti-
macy. Soft addictions lack the sense of powerlessness,
dependency, and compulsion that is typical of standard
addictions and the harm they cause is relatively innoc-
uous. By recognizing them as addictions that concept
creeps downward into the realm of bad habits and
other repetitive pleasurable behaviors where there is a
risk of inappropriate diagnosis. As Petry (2006)
warned, “One must be cautious of where to draw the
line between simply an excessive behavior pattern and
a bona fide psychiatric disorder” (p. 157).
The concept of addiction has clearly undergone a
substantial semantic enlargement in the last few deca-
des, both horizontal and vertical. It can be argued that
this expansion represents something of a return to an
earlier understanding of addiction as being “given
over” some activity. Alexander and Schweighofer
(1988) argued that this broad understanding of addic-
tion, which could include being intensely involved
with desirable activities such as the reading of books,
prevailed until the temperance movement installed a
restrictive, disease-based definition in the mid-19th
century. Even if it is true that the meaning of addic-
tion constricted before it swelled, it is the expansion
that has taken place in recent decades that concerns
this article. Some elements of that expansion have a
solid scientific basis, grounded in the many common-
alities of substance and behavioral addictions, but the
key point for my argument is the fact of the expan-
sion, not whether it is well justified.
Case Study 6: Prejudice
In examining concept creep in the domain of prej-
udice, we move from the domain of clinical psychol-
ogy to social psychology. Prejudice is one of the
most well-researched topics within the field, repre-
senting a form of intergroup animosity that social
psychologists have been eager to study, theorize, and
address since Allport’s (1954) The Nature of Preju-
dice, the seminal work on the subject. As Dixon, Lev-
ine, Reicher, and Durrheim (2012) documented,
Allport understood prejudice to involve intergroup
antipathy: The prejudiced person holds hostile atti-
tudes toward members of an outgroup. This definition
of prejudice as negative evaluation of outgroups has
persisted, featuring in many textbook definitions.
However, Dixon and colleagues argued that the idea
of prejudice-as-antipathy may not be sufficient, and
social psychological accounts of prejudice in the past
three decades have begun to broaden it.
Early social psychological researchers began with
an understanding of prejudice as blatant bigotry,
examining endorsement of hostile and derogatory
statements about African Americans, Jews, and
others. However, as rates of endorsement of these
statements began to wane later in the 20th century,
the understanding of prejudice was broadened.
McConaghy (1986) drew a distinction between “old-
fashioned” racism, exemplified by endorsement of
explicit bigotry, and a subtler and more prevalent
“modern” racism. Modern racists, like so-called
“symbolic” racists (Sears, Henry, & Kosterman,
2000), do not endorse direct hostility to traditional
targets of prejudice but instead denied the continuing
existence of racism and expressed opposition to affir-
mative action policies. It was possible to score high
on a questionnaire measure of modern racism, and
later sexism, without agreeing with any derogatory
evaluations of the target group. Nevertheless, such
scores were taken to indicate prejudice because they
were conceptualized as revealing tacit negative evalu-
ations and were associated with other indicators of
prejudice, such as discriminatory behavior.
The ideas of modern and symbolic racism
extended the concept of prejudice from direct,
expressed antipathy to a group to inferred antipathy:
Modern and symbolic racists held hostile attitudes
toward racial outgroups but suppressed them, know-
ing better than to reveal socially prohibited senti-
ments on questionnaires. Two new ideas extended the
concept of prejudice even further. The concept of
aversive prejudice (Dovidio & Gaertner, 2004)
applies to liberally minded people who deny personal
prejudice but hold aversions, sometimes unconscious,
to other-race people. These aversions are not based
on hostile antipathy by on fear, unease, or discomfort.
The related concept of implicit prejudice (Dovidio,
Kawakami, & Gaertner, 2002) referred to people who
unconsciously linked negative concepts with racial
minority groups more strongly than with majority
groups, as demonstrated by tasks such as the Implicit
Association Test. The ideas of implicit and aversive
prejudice can be prejudiced not only if they suppress
their negative racial sentiments but even if they are
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unaware of having them. Just as some critics had
rejected the claim that modern or symbolic racism is
true prejudice, arguing that it could merely indicate
sincerely held conservative opinions (Sniderman &
Tetlock, 1986), later critics challenged the view that
automatic associations between racial outgroups and
negative stimuli necessarily implied prejudice as dis-
tinct from knowledge of widely held stereotypes
(Arkes & Tetlock, 2004).
Although modern, symbolic, aversive, and implicit
prejudices are less blatant and hostile than the
old-fashioned variant that dominated early prejudice
research, they retain the view that prejudice involves
negative group evaluations. Further extensions of the
concept of prejudice relaxed this requirement. The
concept of benevolent sexism (Glick & Fiske, 1996)
extended prejudice to include group evaluations that
were at least superficially warm and positive. Benev-
olent sexists idealize women as pure creatures who
are too delicate and morally superior to inhabit the
hurly-burly public world of men.
All of the forms of prejudice just reviewed are usu-
ally understood from the standpoint of the perpetrator
of prejudice. Particular social actors are prejudiced,
and their attitudes are objective elements of their psy-
chology. However, some research implies that preju-
dice exists at least in part in the eyes of the target.
Research on microaggressions (Sue et al., 2007), for
example, takes the target’s perceptions of prejudice
as clear evidence of its existence: If a target perceives
a slight as evidence of prejudice, then it is taken as
such, even if the slight is ambiguous and its author
denies it. Of course, many prejudiced acts are unam-
biguous, target perceptions may tend to be accurate,
and denials of prejudice are frequently not credible.
Nevertheless, to count perceived discrimination and
ambiguous microaggressions as unqualified instances
of prejudice is to subjectivize the concept. In addition
to this subjectivity, the concept of microaggression
extends the concept of prejudice by encompassing
acts of omission and phenomena that reflect anxiety
rather than hostility. Proposed examples of microag-
gression include the faltering speech, trembling
voice, and mispronunciation of words by anxious
White therapists discussing racial issues with minor-
ity clients, and “the sheer exclusion of decorations
or literature that represents various racial groups”
in environments that they inhabit (Sue et al., 2007,
p. 274).
These more recent understandings of prejudice
extend its meaning far beyond the blatant antipa-
thy that was the original phenomenon of interest
to Allport and other early social psychologists.
Prejudice is no longer exclusively blatant, but can
be subtle and nonconscious. It is not necessarily
hostile, but can be anxiously avoidant or patronis-
ingly positive. It may not even be inherent in the
acts or attitudes of a prejudiced person, existing
instead in another person’s perception. This expan-
sion of the meaning of prejudice reflects a process
of vertical concept creep in which the concept’s
elastic boundaries stretch to include increasingly
mild and subtle phenomena.
Examples of horizontal creep also exist in the
domain of prejudice, as new forms are recognized that
early psychologists would not have dreamed of. Those
psychologists primarily studied varieties of racism,
including anti-Semitism, whereas researchers now also
study prejudices based on sexual orientation, gender
identity, religion, physical appearance and stature,
marital status, and even species. (Some of these preju-
dices—homophobia, transphobia, Islamophobia—also
illustrate the horizontal creep of the concept of phobia
from irrational fear to attitudinal aversion.) The expan-
sion of the concept of prejudice has been both horizon-
tal and vertical.
It is important to reiterate here that by document-
ing the expanding meaning of prejudice in recent
social psychology I am not questioning the validity of
this expansion or advocating a return to a narrower
understanding of the concept. Each extension of the
concept of prejudice was arguably well justified. The
idea of modern prejudice was justified by changing
social conditions: public disapproval of racial bigotry
drove blatant prejudice underground, where it contin-
ued to promote discriminatory behavior. The notion
of implicit prejudice was justified by emerging evi-
dence of the influence of nonconscious processes on
social behavior. The failure of social integration in
the absence of intergroup antipathy gave a warrant to
the idea of aversive prejudice. “Benevolent sexism”
was justified by the realization that patronizing atti-
tudes protect women from full participation in the
public sphere rather than from their own fragility.
Ideas of perceiver-defined prejudice and microag-
gression can be justified by evidence that displays of
prejudice can have harmful effects on their targets
while remaining subtle and deniable. It is possible to
define “prejudice” in a coherent way that encom-
passes all of these variants. My point is simply that
the concept now refers to much more than it did
several decades ago.
Overview of the Case Studies
These six conceptual case studies replicate a pattern
of semantic enlargement and point to a few consistent
ways in which it has taken place. First, most of the
concepts have stretched to include milder, subtler, or
less extreme phenomena than those to which they
referred at an earlier time. This stretching is evident in
definitions of abuse that can count angry arguments as
instances of emotional abuse, definitions of bullying
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that can include once-off displays of office tyranny,
relaxed diagnostic criteria for mental disorders such as
depression, the recognition of nonconscious forms of
prejudice, and definitions of trauma that allow vicari-
ous experiences to be counted as traumatic.
Second, some of the concepts that initially referred
to the commission of undesirable acts have stretched
to include acts of omission and avoidance. This pat-
tern is illustrated by the inclusion of neglect within
the concept of abuse, the growing recognition of
exclusionary forms of bullying, and the proposal of
aversive forms of prejudice that involve avoidance of
others rather than hostile attack.
Finally, several concepts have acquired a more
subjective aspect. Emotional abuse may be claimed if
one party feels abused rather than by a set of objec-
tive abusive behaviors, bullying if employees per-
ceives that their work has been criticized too harshly,
prejudice if its target perceives it despite the sincere
protestations of the perpetrator, and trauma if its vic-
tim experiences classic posttraumatic symptoms even
if the triggering event would not qualify as traumatic
on classical criteria.
In sum, then, conceptual creep has occurred across
a diverse assortment of concepts and has commonly
involved an increased sensitivity to negative experi-
ence and behavior, an increased focus on harmful
forms of inaction, and an increased acceptance of sub-
jective criteria for deciding when the concepts apply.
Explaining Concept Creep
The preceding sections illustrate how the mean-
ings of some of psychology’s concepts have dilated
in recent decades. The six case studies reveal similar
patterns of horizontal and vertical expansion in con-
cepts drawn from developmental, social, and clinical
psychology. The consistency of this pattern across
diverse concepts calls for a generalized explanation
rather than separate explanations for each. For exam-
ple, although the expansion of mental disorder could
be attributed to the rise of “therapism” (Sommers &
Satel, 2005) or medicalization (Frances, 2013), the
expansion of abuse and trauma to an emerging
“culture of fear” that is preoccupied with risk (Furedi,
2006), and the expansion of prejudice to “political
correctness,” the fact that similar expansions of
meaning occur across these disparate concepts sug-
gests that a more general phenomenon may be
implicated.
A strong and parsimonious explanation of concept
creep should therefore be capable of accounting for
the generality of the phenomenon. It should also pro-
vide satisfactory answers to three key questions. First,
it should be able to account for why semantic expan-
sion rather than contraction occurs. If human kinds
are intrinsically fluid, as Hacking maintained, why
have their meanings spread rather than receded? Sec-
ond, a good explanation for concept creep should
account for why the conceptual expansion is asym-
metrical, evident only for negative concepts. It is dif-
ficult to find examples of semantic inflation among
psychology’s positive concepts, with the arguable
exception of intelligence. Third, an adequate explana-
tion of concept creep should be capable of accounting
for both horizontal and vertical expansion, the quali-
tative and quantitative aspects of the phenomenon.
One possible explanation of concept creep is that
the concepts in question are human kinds in
Hacking’s sense rather than natural kinds. None of
them refer to timeless categories that are independent
of social convention and practice. Similarly, none of
them have sharp, discoverable category boundaries
that psychology’s definitions might try to approxi-
mate. For example, most mental disorders—not to
mention the concept of mental disorder itself—fall on
a continuum with normality and with other disorders:
The psychiatric domain is a spectral blur rather than a
collection of discrete conditions (Haslam, Holland, &
Kuppens, 2012). Definitions of human kinds are
therefore bound to be in flux.
The fact that human kinds are not natural kinds
explains why psychology’s concepts may have elas-
tic meanings, but it does not explain concept creep
adequately. Having elastic conceptual boundaries
does not dictate that those concepts should expand.
In principle, concepts with intrinsically flexible
definitions should be just as likely to contract their
meanings. The unnaturalness of human kinds also
fails to explain why concept creep is most evident
for negative concepts or why it takes horizontal
and vertical forms. Finally, it does not offer a uni-
fying explanation for the common pattern of expan-
sion across concepts. The fact that psychology’s
concepts are human kinds enables creep but does
not explain it.
Another class of explanations invokes technologi-
cal and societal change. By these accounts, concept
creep is a response to altered social realities.
Cyber-bullying and Internet addiction, for example,
could not exist before the emergence of the Internet.
The horizontal expansion of the concepts of bullying
and addiction to include them simply reflects the
emergence of a new online medium in which intimi-
dation and dependency can occur. Similarly, the hori-
zontal creep of the concept of prejudice could be
attributed to the rising prominence of minority
groups, such as transgendered people and Muslims,
in societies where they had not previously been
salient. In these instances, concept creep is a side
effect of large-scale societal changes, in which new
forms of an existing phenomenon are added by
accretion.
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Explanations of this kind may have some merit,
but they also have limitations. It is difficult to identify
a single technological or other societal development
that could drive the generalized expansion of con-
cepts as disparate as bullying, mental disorder, and
prejudice. Although accounts that invoke such devel-
opments can explain why concepts tend to broaden
rather than narrow, as with cyber-bullying, they fail
to account for why that broadening should be clearer
for negative concepts. Unless technological and soci-
etal change has uniformly negative implications, it
should also broaden positive concepts. In addition,
such change can explain horizontal expansion—the
addition of new forms of experience or behavior
enabled by new technologies or social conditions—
but it is unclear how it could account for vertical
expansion. Why technological or societal change
should lower the threshold for detecting established
forms of behavior or experience is unclear.
A third kind of explanation for concept creep
implicates psychology as a field of knowledge rather
than societal or technological change. It could be
argued that just as successful species increase their
territory, invading and adapting to new habitats, suc-
cessful concepts and disciplines also expand their
range into new semantic niches. Concepts that suc-
cessfully attract the attention of researchers and prac-
titioners are more likely to be applied in new ways
and new contexts than those that do not. For example,
the success of the concept of bullying in the develop-
mental psychology literature of the 1970s and 1980s
may have made it an appealing concept to apply to
analogous behavior observed in workplaces for schol-
ars working in the 1990s. This tendency for success-
ful concepts to colonize new semantic territory has
several dimensions. Concepts that are particularly
illuminating may be more readily extended by anal-
ogy, and those that receive more academic attention
may be more readily extended as researchers strive to
make novel contributions in a crowded marketplace
of ideas. The former possibility implicates the intrin-
sic properties of successful concepts, whereas the lat-
ter implicates the dynamics of popular research
topics.
Figure 1 shows how many of the creeping con-
cepts from the case studies have indeed become more
prominent in recent decades. Panels (a) to (e) present
data on the relative frequency with which particular
words appear in Google’s Ngram database of approx-
imately 5 million books (Michel et al., 2011),
reported separately for books published at 10 time-
points from 1960 to 2005. These relative frequencies
are scaled so that 100 represents the highest relative
frequency for each word across the 10 time-points
(i.e., the highest relative frequency of the word over
the period in question). In every case, the relative fre-
quency of words associated with abuse, bullying,
Figure 1. Rising usage of words denoting (a) abuse, (b) bullying, (c)
trauma, (d) addiction, and (e) racism from 1960 to 2005, as a propor-
tion of all words in the Google NGram corpus, and static usage of (f)
psychology. Values are scaled so that 100 represents the highest pro-
portion obtained for the term at any of the 10 time-points.
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trauma, addiction, and prejudice has risen steeply,
especially in the period 1970–2000, reaching peak
salience in the most recent time-points. If increases in
the salience of particular concepts can drive the
expansion of concept meanings, these graphs demon-
strate the plausibility of this mechanism of concept
creep.
The “Darwinian concepts” account, according to
which more successful concepts tend to expand their
semantic range, has significant promise as an explana-
tion of concept creep. Psychological concepts have
had unquestionable cultural success in recent decades,
with writers pointing to the rising “psychologization”
of experience in postwar society (De Vos, 2010). The
discipline has grown steeply in public influence,
research output, professional numbers, and undergrad-
uate enrolments, and as Horwitz and Wakefield (2007)
observe, “all professions strive to broaden the realm of
phenomena subject to their control” (p. 213). The psy-
chologization account can explain why several nega-
tive concepts have expanded rather than contracted
their semantic range. It can account for what ties these
conceptual changes together as a general phenomenon:
all of the concepts in question are prominent psycho-
logical ideas. It may also account for the asymmetrical
tendency for negative rather than concepts to expand,
in view of the discipline’s disproportionate emphasis
on negative phenomena (Gable & Haidt, 2005). Argu-
ably the psychologization account can also explain
why both vertical and horizontal forms of expansion
have taken place. It proposes that successful and popu-
lar concepts have a tendency to inflate, and that ten-
dency could be expressed equally well by bringing
new phenomena under the concept’s semantic
umbrella or by extending the concept downward to
more subtle phenomena.
Although an explanation of concept creep that
emphasizes factors internal to the discipline of psy-
chology is promising, there is evidence that the psy-
chologization account is insufficient. Figure 1’s panel
(f), for example, shows that psychology itself, at least
as indicated by the relative frequency of use of the
word “psychology” and “psychological,” has not
become more salient during the period when the
creeping concepts have crept most vigorously, and
has in fact declined to some degree. I propose that a
broader cultural shift may be implicated in concept
creep. That shift can be approached through the anal-
ysis of historical trends in violent behavior offered by
Pinker (2011). Pinker documents a relentless decline
in all forms of violence over several time-scales.
Over the recent decades that are the focus of my anal-
ysis, Pinker identifies the “rights revolutions” as the
main driver of this reduction. Movements for the
rights of women and minorities have conducted what
he describes as a “civilizing offensive” targeting
forms of aggression and inequity that had previously
been accepted. Their campaigns “are propelled by an
escalating sensitivity to new forms of harm” (p. 460).
Pinker argues that although the prescriptions of these
campaigns can seem excessive—as an example he
gives the prohibition of schoolyard dodgeball—they
simply reflect an overshooting of that well-motivated
sensitivity to harm.
Pinker’s analysis offers a way to comprehend con-
cept creep in terms of wider cultural trends rather
than those that originate within psychology. It can
explain why conceptual change should be expansion-
ary and why it should apply asymmetrically to nega-
tive (i.e., harm-related) concepts. Its claim that the
driving force in the phenomenon is a rising sensitivity
to “new forms of harm” (horizontal expansion) and to
“the slightest trace of a mindset that might lead to it”
(p. 469) (vertical expansion) indicates that it can
explain both dimensions of creep. The only limitation
of Pinker’s analysis as an account of concept creep is
that it is specifically addressed to the topic of violence
rather than negativity in general. The idea that the
rights revolutions were based on “a rising abhorrence
to violence” (p. 469) can help to explain the expan-
sion of concepts directly related to violence such as
abuse and bullying, and it could be stretched to
explain the enlargement of less directly related con-
cepts such as prejudice and trauma. However a vio-
lence-based analysis cannot account for the
expansion of unrelated concepts such as mental disor-
der and addiction. Nevertheless, an extension of
Pinker’s argument that sees the “civilizing offensive”
as involving not only a desire to eradicate violence
but also a general sensitization to harm could go a
long way toward accounting for concept creep.
I would contend that concept creep represents a
combination of intellectual forces at work within psy-
chology and cultural trends as work within society at
large. These forces and trends overlap. Psychology
has played a role in the liberal agenda of sensitivity
to harm and responsiveness to the harmed, and the
growth of the field and its increased focus on negative
phenomena—social and personal harms such as
abuse, addiction, bullying, mental disorder, prejudice,
and trauma—has been symptomatic of the success of
that social agenda.
Implications of Conceptual Creep
If concept creep is real, how are its implications to
be evaluated? What ‘looping effects’ might the
altered extensions of psychology’s negative concepts
have on the self-understanding of people to whom
they apply and on the views of the wider public?
Those drawn to a pessimistic assessment of these
changes might argue that the expanding meaning of
concepts such as abuse, bullying, and mental disorder
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is creating a culture of weakness, fragility, and
excuse-making, in which everyone is a victim and no
one is responsible for their predicament. Those drawn
to a more optimistic assessment might applaud the
growing sensitivity to suffering and maltreatment. A
balanced evaluation of concept creep would be more
ambivalent, falling somewhere between conservative
reaction and liberal celebration.
The nature of this ambivalence is well captured by
the work of moral psychologists. Concept creep can be
seen as a form of expansion of the ‘moral circle’
(Laham, 2009; Singer, 1981), representing an enlarge-
ment of the sphere of people whose experiences or
behavior are recognized by psychologists as deserving
of moral concern. I have argued that the basis of this
expansion is a rising sensitivity to harm, implicating the
harm/care moral foundation (Graham, Nosek, Haidt,
Iyer, Koleva, & Ditto, 2011). This foundation is
strongly associated with political liberalism (Graham,
Haidt, & Nosek, 2009), as well as with empathy and
compassion (Graham et al., 2011). In essence, the con-
cept creep phenomenon broadens moral concern in a
way that aligns with a liberal social agenda by defining
new kinds of experience as harming and new classes of
people as harmed, and it identifies these people as need-
ful of care and protection.
As an expansion of the moral circle into new and
milder forms of harm, concept creep might appear to be
an entirely beneficial sign of moral progress. It defines
previously tolerated forms of abusive, domineering, and
discriminatory behavior as problematic, and extends pro-
fessional care to people who experience adversity and
suffering that would once have been ignored. However,
by increasing the range of people who are defined as
moral patients—people worthy of moral concern, based
on their perceived capacity to suffer and be harmed (H.
M. Gray, Gray, & Wegner, 2007)—it risks reducing the
range of people who see themselves as capable of moral
agency. According to research on ‘moral typecasting’
(K. Gray & Wegner, 2009), there is an inverse relation-
ship between moral patiency and agency, such that peo-
ple tend to be typecast either as victims who suffer harm
but lack responsibility and the capacity to act inten-
tionally, or as perpetrators who are blameworthy but
lack the capacity to suffer. A possible adverse looping
effect of concept creep is therefore a tendency for more
and more people to see themselves as victims who are
defined by their suffering, vulnerability, and innocence,
and who have diminished agency to overcome their
plight. The flip-side of this expanding sense of victim-
hood would be a typecast assortment of moral villains:
abusers, bullies, bigots, and traumatizers.
Moral typecasting theory helps to understand some
of the mixed blessings of concept creep. Consistent
with Pinker’s analysis of violence, the expanding reach
of psychology’s negative concepts is likely to have civi-
lizing effects, sensitizing people to harm and suffering.
Identifying intimidation at work as bullying rather than
tolerating it as office politics is an important step
towards creating more nurturing workplaces. Similarly,
recognizing an extended range of problems as mental
disorders, and a wider variety of life events as traumas,
promotes treatment over neglect and sympathy over
blame, a common problem for people whose troubles
are often moralized as signs of personal weakness.
However, these extensions of harm-based moral
concern also have a dark side. Expanding the concept
of mental disorder can pathologize normal experien-
ces, generate over-diagnosis and over-treatment, and
engender a sense of diminished agency. There is evi-
dence that people understand their psychological
problems as psychiatric diseases tend to be more pes-
simistic about recovery and less confident of their
capacity to exert control over their difficulties (Has-
lam & Kvaale, 2015; Lebowitz, 2014). Similarly,
identifying a self-destructive behavior as an addiction
encourages people to see themselves as powerless in
the face of it, a perception that provides an exculpa-
tory moral benefit but also a cost in likelihood of self-
change. Although gambling is the only behavioral
addiction to be ratified by DSM, popular discourse is
riddled with supposed addictions to love, sex, mobile
phones, and video games. Expansion of negative con-
cepts such as addiction within psychology is likely to
trickle down to the lay public, shaping the experience
and self-understanding of many more people than the
psychology profession can influence directly.
Concept creep may have additional adverse side-
effects beyond those attributable to moral typecasting.
First, by applying concepts of abuse, bullying, and
trauma to less severe and clearly defined actions and
events, and by increasingly including subjective ele-
ments into them, concept creep may release a flood of
unjustified accusations and litigation, as well as exces-
sive and disproportionate enforcement regimes (Cascardi
et al., 2014). Second, concept creep can produce a kind
of semantic dilution. If a concept expands to encompass
less extreme phenomena than it did previously, then its
prototypical meaning is likely to shift in that direction. If
trauma, for example, ceases to refer exclusively to terri-
fying events that are outside normal human experience,
and is applied to less severe and more prevalent stresses,
then it will come to be seen in a more benign light. As
Weathers and Keane (2007) remark:
it is essential to set a threshold of stressor severity as
part of the diagnostic criteria for PTSD. Doing other-
wise would result in a substantial departure from the
original conceptualization of PTSD and risk trivializ-
ing the suffering of those exposed to catastrophic life
events (p. 114)
Similarly, people whose experience fits the more
stringent early definition of other negative
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concepts—who have suffered sexual abuse, melan-
cholic depression, hostile bigotry—may find that
experience downplayed or trivialized when it is
equated to the less severe experiences that fit under
the new, expanded definition. In extreme situations,
the meaning of negative concepts can be almost
completely debased, as when people describe their
ordinary, transient sadness as ‘depression.’
Conceptual expansion also carries risks for psy-
chological research and practice. The enlarged mean-
ings of the concepts discussed in this paper have
produced semantic overlaps, and increasingly these
concepts can be applied to the same phenomena. An
episode in which one person uses an ethnic slur
towards another can now count as abuse, bullying,
trauma, and prejudice by some definitions. The verti-
cal expansion of trauma to include relatively mild
maltreatments and of bullying to encompass single
incidents, and the horizontal expansion of abuse to
include events causing emotional harm, mean that
their meanings have become somewhat redundant.
This redundancy can lead to conceptual confusion
and parallel literatures that address similar phenom-
ena using different terminology.
A final risk of conceptual creep concerns the pub-
lic’s view of psychology itself. The more the field is
seen to traffic in concepts that emphasize the undesir-
able and pathological in human life, and the more
those concepts are seen as encompassing normal expe-
rience, psychology will be identified with negativity
and a view of people as dysfunctional victims. The
positive psychology movement has laid out this cri-
tique based on what it sees as the disproportionate
focus of the field on negative phenomena, and I sug-
gest that the expansion of negative concepts makes
this issue even more salient. Concept creep runs the
risk of creating a public impression of psychology as a
field that exaggerates misery, inflates mental disorder,
excuses misbehavior, and is oversensitive to perceived
bias and discrimination. None of these impressions
may be justified, but a serious appraisal of conceptual
creep must reckon with these potential downsides.
Conclusions
The expansion of psychology’s negative concepts
represents a historical development that has signifi-
cant implications for the field and for the wider soci-
ety that it influences. There is a consistent trend for
these concepts to encompass an increasingly broad
range of human behavior and experience, and for
their meanings to spread and change as a result.
Understanding what drives this trend and evaluating
its costs and benefits are important goals for people
who care about psychology’s place in our cultures.
Equally important is the task of deciding whether the
trend should be encouraged, ignored, or resisted. Ulti-
mately this question depends on whether we would be
content for most interpersonal frictions to be ascribed
to abuse and bullying, for everyday stresses to be
described as traumas and habits as addictions, for
mental disorder to be more common than its absence,
and for prejudice to be seen as a constant undercur-
rent in social life.
Note
Address correspondence to Nick Haslam, Mel-
bourne School of Psychological Sciences, University
of Melbourne, Parkville VIC 3010, Australia. E-mail:
nhaslam@unimelb.edu.au
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