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Definition of a Mental Disorder

Definition of a Mental Disorder

A proposed revision for the definition of a mental disorder is being addressed by select members of the Anxiety, Obsessive-Compulsive, Posttraumatic, and Dissociative Disorders Work Group, a member of the Mood Disorders Work Group, and additional individuals (see Stein DJ et al: What is a Mental/Psychiatric Disorders? From DSM-IV to DSM-V; Psychological Medicine, 2010; in press) 

Features

A.  A behavioral or psychological syndrome or pattern that occurs in an individual
 
B.  The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)
 
C.  Must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals)
 
D.  That reflects an underlying psychobiological dysfunction
 
E.  That is not primarily a result of social deviance or conflicts with society   
 
Other Considerations
 F.  That has diagnostic validity on the basis of various diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment)
 
G.  That has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment)
 
 H.  No definition perfectly specifies precise boundaries for the concept of either “medical disorder” or "mental/psychiatric disorder”
 
I.  Diagnostic validators and clinical utility should help differentiate a disorder from diagnostic “nearest neighbors”
 
J.  When considering whether to add a mental/psychiatric condition to the nomenclature, or delete a mental/psychiatric condition from the nomenclature, potential benefits (for example, provide better patient care, stimulate new research) should outweigh potential harms (for example, hurt particular individuals, be subject to misuse)

Rationale for proposed revisions are reflected in Stein DJ et al: What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V; Psychological Medicine (2010; in press)

A. The phrase “clinically significant” is moved to the next criterion, to emphasize that disorders are characterized by clinically significant distress or impairment.

B. The phrase on risk is omitted in order to differentiate more clearly between disorders and risk factors.

C. The phrase on responses to common stressors and losses is added to differentiate more clearly between such responses and psychopathology.

D. The term psychobiological is used to emphasize the inextricable links between the biological and the behavioral/psychological.

E. There is no substantive change here; the proposed version is more succinct.

 

Other Considerations: 

F. Diagnostic validity and clinical utility are key constructs in the delineation of disorder.

It may be timely to reconsider the term “mental disorder”, given our growing knowledge of the psychobiology of these disorders. In considering new disorders for DSM-V, we need to consider their relationship with diagnostic “near-neighbors”, and the overall benefits vs harms of an addition.

There are no severity criteria associated with this revision.

Definition of a Mental Disorder

Features

A.  A clinically significant  behavioral or psychological syndrome or pattern that occurs in an individual
 
B.  Is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom
 
C.  Must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one
 
D.  A manifestation of a behavioral, psychological, or biological dysfunction in the individual
 
E.  Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual
 
Other Considerations
F.  No definition adequately specifies precise boundaries for the concept of "mental disorder”
 
G.  The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations

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