When Do Normal Emotions Become Medical Problems?

The fine line between medicalizing normal and dismissing despair

May 13, 2025

ICYMI 👉

This Friday’s LIVE Q&A is about MENTAL & PHYSICAL HEALTH. I’ll be talking with best-selling author and physician Dr. Aditi Nerurkar about managing stress & the mind-body connection. Join us on Friday May 16 at 3 pm ET - right here!!

Last month, I met with a patient we will call “Rachel,” a 56-year-old professional woman who came to see me about what she described as "unusual irritability."

Rachel had been known for being calm during chaos at work and at home. But after her firm merged with a larger company, she found herself uncharacteristically short-tempered. Small inconveniences triggered disproportionate frustration, her sleep became restless, and tension headaches occurred with increasing frequency.

What brought Rachel to my office wasn't just the irritability itself, but confusion about how to interpret it. Her husband suggested she might be depressed. Her business partner advised her to “ride out the stress." Her girlfriend urged her to take time off for self-care. But none of this advice felt right. She wasn't sure if she was experiencing a normal reaction to change or if her mental health was truly at risk.

Rachel’s story reflects a common question many of us face: how do we distinguish between ordinary human emotions and those that might benefit from professional support?

brown wooden table — Photo by Apaha Spi on Unsplash

Drawing Lines in the Emotional Sand

The history of psychiatric diagnosis reveals our shifting understanding of where "normal" ends and "disorder" begins. When the DSM (Diagnostic and Statistical Manual of Mental Disorders) was first published in 1952, it contained 106 disorders. Today's DSM-5-TR includes over 300.

Consider grief. For decades, the DSM explicitly distinguished between normal grief and depression, acknowledging that deep sadness and sleep disturbance are natural responses to loss—not disorder symptoms. Yet in the DSM-5, this "bereavement exclusion" was removed, opening the possibility that normal grief responses could now meet criteria for major depression.

These shifts reflect a genuine desire to help people who are suffering. They also reflect our culture's evolving attitudes about what emotions and behaviors are considered acceptable, normal, or desirable.

Our Relationship with Difficult Emotions

We live in a culture that often views happiness and productivity as the baseline expectation. Anxiety, sadness, and anger are frequently seen as problems to eliminate rather than natural parts of a complete human life.

Social media compounds this by presenting curated versions of others' lives, creating the impression that everyone else is thriving while we struggle. Our fast-paced world also offers fewer spaces to process emotions naturally. When difficult feelings interfere with our productivity or relationships, we may view them as dysfunctional rather than as meaningful signals worthy of attention.

This cultural context doesn't create our emotional struggles, but it shapes how we interpret them. It encourages us to ask, "What's wrong with me?" rather than "What is this emotion telling me?" or "What in my environment might need to change?"

The Problem with Binary Thinking

When we talk about mental health conditions in medicine, we often use simple yes/no categories: you have depression or you don't; you have anxiety or you're fine. But in reality, our emotional lives rarely fit into such neat boxes. Most of us move back and forth along a spectrum of feelings. The intensity of our sadness, worry, or irritability shifts naturally over time, sometimes approaching what might be considered a clinical threshold, other times falling well within typical ranges. These experiences don't suddenly transform from "completely normal" to "definitely disordered" when they cross an arbitrary line—they exist on a continuum.

This is why many researchers and clinicians now advocate for a dimensional approach to understanding mental health. Instead of asking whether someone has a disorder, we consider where they fall on various spectrums of emotional experience, behavior, and functioning.

A dimensional understanding acknowledges that all humans experience anxiety, sadness, and other difficult emotions. The question isn't whether someone experiences these emotions, but rather:

How intense are they?
How persistent are they?
How much do they interfere with daily functioning?
How proportional are they to the person's circumstances?
How well can the person regulate these emotional states?

The dimensional approach allows us to recognize when someone needs support without necessarily pathologizing their experience.

Context Matters

Context plays a crucial role in understanding our emotional experiences. The same feeling can have very different meanings depending on what's happening in our lives. Most people naturally distinguish between emotions with an obvious cause and those that seem to appear out of nowhere.

For instance, feeling sad after losing a job makes sense to both the person experiencing it and those around them. The same sadness without any apparent reason often feels more concerning, even if the symptoms look identical.

Research shows people clearly differentiate between sadness with and without cause. We generally view unexplained sadness as potentially requiring medical help, while seeing sadness with an obvious trigger as a normal response that might need different kinds of support. This natural human insight reminds us that symptoms alone don't tell the full story of our emotional experiences.

Find Your Place on the Emotional Spectrum

So how can you—someone who isn't a mental health professional—navigate this complex terrain? Here are some practical considerations that might help:

Consider the impact on your functioning. Some anxiety before a job interview is normal. Anxiety that prevents you from applying for jobs altogether might warrant attention. Similarly, sadness after a relationship ends is expected. Sadness that makes it impossible to meet your basic needs for weeks or months might benefit from support.
Examine the context. Are your emotions proportional to your circumstances? Intense fear during a genuinely threatening situation is normal. The same level of fear in objectively safe situations might indicate an anxiety response that's become disconnected from reality.
Track patterns over time. We all have bad days or even bad weeks. But if you notice your difficult emotions are becoming more intense, more frequent, or longer-lasting over time, that pattern is worth attention.
Consider whether your emotional responses feel familiar or foreign. Many people describe knowing something is wrong because their emotional experience feels fundamentally different from their usual self, even during previous difficult times.
Listen to trusted others. Sometimes those close to us can see changes in our behavior or functioning that we don't notice ourselves. If people who know you well and have your best interests at heart are expressing concern, their perspective is worth considering.
Evaluate your coping strategies. If you're using alcohol, substances, excessive work, or other potentially harmful behaviors to manage your emotions, this might indicate that your current coping resources are overwhelmed.

Remember that seeking help doesn't require certainty that you have a "disorder." Mental health professionals can help you understand your emotional experience, whether or not it fits diagnostic criteria. The goal isn't necessarily to diagnose or medicalize your experience, but to find the support that helps you move toward greater well-being and functioning.

Expand Your Emotional Toolkit

Whether or not your emotional experience meets criteria for a diagnosed condition, developing a broader set of skills for working with difficult emotions can benefit everyone. Here are some approaches that research suggests can help across the spectrum of emotional experience:

Build emotional literacy. Many of us weren't taught to identify emotions with precision. Learning to distinguish between similar but distinct emotions (like anxiety vs. excitement, or sadness vs. shame) can help you respond more effectively to what you're feeling.
Practice mindful awareness. Mindfulness—the practice of non-judgmental attention to your present experience—can help create space between you and your emotions. This space allows you to respond thoughtfully rather than react automatically.
Engage in regular physical movement. Our bodies and minds are connected. Regular physical activity can help regulate the biological systems involved in our emotional responses.
Cultivate social connection. Supportive relationships provide both emotional regulation and practical help during difficult times. Even brief positive social interactions can shift our emotional state.
Develop distress tolerance skills. Learning to sit with uncomfortable emotions without immediately trying to fix or escape them can actually reduce their intensity and duration over time.
Practice self-compassion. Treating yourself with the same kindness you would offer a friend during emotional struggle can interrupt self-criticism and shame, which often compound our difficult emotions.

These approaches aren't alternatives to professional help when it's needed, but complementary skills that can benefit anyone navigating life's emotional terrain.

Looking for a good place to start building out your kit? I highly recommend Marsha Linehan’s DBT Skills Training. For an abbreviated version, try DBT for Dummies. DBT stands for Dialectical Behavioral Therapy, and the skills it teaches are extraordinarily simple yet wonderfully empowering.

What my patient Rachel needed wasn’t a name for a particular disorder or quick reassurance, either. Instead, she needed language to describe how she felt and practical skills to manage emotions that have become “too big.”

Her diagnosis? HUMAN.

At the end of the day, the most important question isn't "Do I have a disorder?" but "Is this emotional experience interfering with my ability to live a meaningful, connected life?"

Questions For You

Where do you draw the line for yourself between "normal" emotions versus something that needs more attention?
What strategies have you found most helpful for working with difficult emotions?
How do you think our cultural attitudes about emotions shape the way we interpret our own emotional experiences?