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What is a mental/psychiatric disorder? From DSM-IV to DSM-V

  • D. J. Stein (a1), K. A. Phillips (a2), D. Bolton (a3), K. W. M. Fulford (a4), J. Z. Sadler (a5) and K. S. Kendler (a6)
  • DOI:
  • Published online: 20 January 2010

The distinction between normality and psychopathology has long been subject to debate. DSM-III and DSM-IV provided a definition of mental disorder to help clinicians address this distinction. As part of the process of developing DSM-V, researchers have reviewed the concept of mental disorder and emphasized the need for additional work in this area. Here we review the DSM-IV definition of mental disorder and propose some changes. The approach taken here arguably takes a middle course through some of the relevant conceptual debates. We agree with the view that no definition perfectly specifies precise boundaries for the concept of mental/psychiatric disorder, but in line with a view that the nomenclature can improve over time, we aim here for a more scientifically valid and more clinically useful definition.

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Corresponding author
*Address for correspondence: Professor D. J. Stein, UCT Department of Psychiatry, Groote Schuur Hospital J-2, Anzio Rd, Observatory 7925, Cape Town, South Africa. (Email:
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D Bolton (2008). What is Mental Disorder? An Essay in Philosophy, Science, and Values. Oxford University Press: Oxford.

C Boorse (1976). What a theory of mental health should be. Journal of the Theory of Social Behaviour 6, 6184.

MB First , HA Pincus , JB Levine , JBW Williams , B Ustun , R Peele (2004). Clinical utility as a criterion for revising psychiatric diagnoses. American Journal of Psychiatry 161, 946954.

KWM Fulford (1999). Nine variations and a coda on the theme of an evolutionary definition of dysfunction. Journal of Abnormal Psychology 108, 412420.

KS Kendler (1990). Towards a scientific nosology: strengths and limitations. Archives of General Psychiatry 47, 969973.

KS Kendler (2009). An historical framework for psychiatric nosology. Psychological Medicine 39, 17.

KS Kendler , J Myers , S Zisook (2008). Does bereavement-related major depression differ from major depression associated with other stressful life events? American Journal of Psychiatry 165, 14491455.

HM van Praag (2000). Nosologomania: a disorder of psychiatry. World Journal of Biological Psychiatry 1, 151158.

JC Wakefield (1992). Disorder as harmful dysfunction: a conceptual critique of DSM-III-R's definition of mental disorder. Psychological Review 99, 232247.

P Zachar , KS Kendler (2007). Psychiatric disorders: a conceptual taxonomy. American Journal of Psychiatry 164, 557565.

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Psychological Medicine
  • ISSN: 0033-2917
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