scholarly journals What is a mental disorder? An exemplar-focused approach

2021 ◽  
pp. 1-8
Author(s):  
Dan J. Stein ◽  
Andrea C. Palk ◽  
Kenneth S. Kendler
Keyword(s):  
Mental Disorder ◽  
Clinical Utility ◽  
Careful Consideration ◽  
Diagnostic Validity ◽  
Philosophy Of Psychiatry ◽  
Practical Judgment ◽  
Dsm 5 ◽  
Practical Guidelines ◽  
Definition Of ◽  
Practical Implications

Abstract The question of ‘what is a mental disorder?’ is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars – real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.

Obsessive-compulsive and related disorders in DSM-5, ICD-11, and RDoC: Conceptual questions and practical solutions

2017 ◽  
Author(s):  
Dan J. Stein
Keyword(s):  
Anxiety Disorder ◽  
Mental Disorder ◽  
Clinical Utility ◽  
Work Groups ◽  
Integrative Approach ◽  
Evidence Based ◽  
Diagnostic Validity ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Dsm 5

Key nosological questions facing the DSM-5 and ICD-11 work groups on obsessive-compulsive and related disorders (OCRDs) included whether putative OCRDs should be classified together, and whether obsessive-compulsive disorder (OCD) should retain its classification as an anxiety disorder. Given that some of the putative OCRDs were new to the official nosologies, the work groups also had to grapple with the perennial questions of how to decide whether any condition is a mental disorder, and how to draw boundaries between disorder and normality. This chapter reviews some of the conceptual questions that emerged and some of the practical solutions that were suggested. The emphasis on both diagnostic validity and clinical utility is consistent with an integrative approach which holds that nosology should be both evidence-based and values-based.

scholarly journals Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Julija Gecaite-Stonciene ◽  
Christine Lochner ◽  
Clara Marincowitz ◽  
Naomi A. Fineberg ◽  
Dan J. Stein
Keyword(s):  
Personality Disorder ◽  
Scoping Review ◽  
Alternative Model ◽  
Clinical Utility ◽  
Diagnostic Validity ◽  
Factorial Structure ◽  
Factor Analyses ◽  
Dimensional Model ◽  
Obsessive Compulsive ◽  
Dsm 5

Introduction: With the shift from a categorical to a dimensional model, ICD-11 has made substantial changes to the diagnosis of personality disorders (PDs), including obsessive-compulsive (anankastic) personality disorder (OCPD). The ICD-11 PD model proposes a single diagnosis of PD with specifications regarding severity and domains. However, a systematic overview of ICD-11 anankastia is lacking. In this review we address the reformulation of the OCPD diagnosis in the ICD-11, and draw comparisons with the DSM-5, with a particular focus on diagnostic validity and clinical utility. We hypothesized that the ICD-11 PD model provides a diagnostically valid and clinically useful approach to OCPD, with specific emphasis on the anankastia domain as the primary trait qualifier.Methods: Literature published from 2010 to 2020 was systematically searched using the PubMed/MEDLINE, PsychInfo, Cochrane, and Web of Sciences search engines, in order to find all articles that addressed ICD-11 anankastia. Relevant articles were collated, and themes of these articles subsequently extracted.Results: Out of the 264 publications identified, 19 articles were included in this review. Four themes were identified, namely (a) overlap of DSM-5 OCPD with the ICD-11 PD model, (b) the factorial structure of the ICD-11 PD model with respect to the anankastia domain, (c) the clinical utility of the ICD-11 PD model, and (d) comparison of the ICD-11 PD model of anankastia with the DSM-5 alternative model for OCPD.Conclusions: The ICD-11 anankastia domain overlaps with DSM-5 OCPD traits, and the factor analyses of the ICD-11 PD model further support the diagnostic validity of this domain. There is some support for the clinical utility of the ICD-11 PD model of anankastia but further studies are needed, including of its relationship to obsessive-compulsive and related disorders.

Clinical significance, disability, and biomarkers: Shifts in thinking between DSM-IV and DSM-5

2017 ◽  
Author(s):  
Derek Bolton
Keyword(s):  
Mental Disorder ◽  
General Medicine ◽  
External World ◽  
Normal Function ◽  
Dsm 5 ◽  
The Central Nervous System ◽  
Dsm Iv ◽  
Poor Outcomes ◽  
Definition Of ◽  
Made In

Proposals have been made in connection with ICD and DSM revisions to separate the concepts of mental disorder and of impairments in social, occupational, or other important areas of functioning. The proposals are consistent with viewing disability as a social concept rather than a medical one. It is argued here on the basis of two main premises that mental disorder specifically cannot be conceptualized independently of social impairments. The first premise is that in general medicine the definition of disease essentially turns on impairments of normal function of an organ or system leading to poor outcomes. The second, compound premise is that one normal function of the central nervous system is the regulation of behaviour in the external world, and that this function is approximately the domain of the mental. The conclusion is drawn that mental disorder conceptually involves downturn in social, occupational, or other important areas of functioning.

SM-5, ICD-11, RDoC and the Future of Psychiatric Classification

2017 ◽  
Vol 41 (S1) ◽  
pp. S31-S31
Author(s):  
M. Maj
Keyword(s):  
Clinical Utility ◽  
Psychiatric Diagnoses ◽  
Diagnostic Categories ◽  
Dsm 5 ◽  
Clinical Phenomenology ◽  
Behavioural Phenotypes ◽  
Competing Interest ◽  
The One ◽  
Definition Of ◽  
Psychiatric Profession

The publication of the DSM-III in 1980 was intended to be a reaction to the evidence of the embarrassingly low reliability of psychiatric diagnoses, which was perceived as a major threat to the credibility of the psychiatric profession. The aims of the DSM-III project were actually two. First, the reliable definition of the diagnostic categories was expected to lead to the collection of research data that would validate those diagnostic entities and in particular elucidate their etiopathogenetic underpinnings. Second, there was an expectation that, by increasing reliability, communication among clinicians would be improved and clinical decisions made more rational. Today, one could say that the first aim of the project has not been achieved, while the fulfilment of the second aim has never been tested appropriately. The crisis of confidence in the DSM paradigm, clearly emerging from the debate following the publication of the DSM-5, has led on the one hand to a renewed emphasis on clinical utility, which is featuring prominently in the ongoing process of development of the ICD-11. On the other hand, it has led to a radical attempt to reform psychiatric nosology starting from neurobiological and behavioural phenotypes. This attempt does have its weaknesses, but may also represent a stimulus to reconceptualize some psychopathological constructs, especially in the area of psychoses, in order to reduce the gap between the level of neuroscience and that of clinical phenomenology.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals The DSM-5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review

2021 ◽  
Vol 43 (4) ◽  
Author(s):  
M. Cristina Amoretti ◽  
Elisabetta Lalumera ◽  
Davide Serpico
Keyword(s):  
Mental Disorder ◽  
Communication Disorders ◽  
Autism Spectrum ◽  
Response To Treatment ◽  
Communication Disorder ◽  
Validity And Reliability ◽  
Dsm 5 ◽  
The Social ◽  
Pragmatic Communication ◽  
Definition Of

AbstractThe latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included the Social (Pragmatic) Communication Disorder (SPCD) as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of (some forms of) Autism Spectrum Disorder (ASD). This opens up the possibility that individuals with very similar symptoms can be diagnosed differently (with either ASD or SPCD) and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography.

Philosophical Issues in Psychiatry IV

2017 ◽  
Keyword(s):  
Steering Committee ◽  
Psychiatric Research ◽  
Psychiatric Diagnoses ◽  
Foreseeable Future ◽  
Philosophy Of Psychiatry ◽  
Psychiatric Nosology ◽  
Dsm 5 ◽  
Wide Range ◽  
Continuous Improvement Model ◽  
Definition Of

This book contains, in addition to an introduction, sixteen chapters, each with its own introduction and discussion, that review various issues within psychiatric nosology from clinical, historical and particularly philosophical perspectives. The contributors to this book include major psychiatric researchers, clinicians, historians and especially nosologists (including several leaders of the DSM-5 effort and the DSM Steering Committee that will be guiding future revisions in DSM for the foreseeable future), psychologists with a special interest in psychiatric nosology and philosophers with a wide range of orientations. The book is organized into four major sections. The first explores the nature of psychiatric illness and the ways in which define it including clinical and psychometric perspectives. The second section examines problems in the reification of psychiatric diagnostic criteria, the problem of psychiatric epidemics and the nature and definition of individual symptoms. The third session explores the concept of epistemic iteration as a possible governing conceptual framework for the revision efforts for official psychiatric nosologies such as DSM and ICD and the problems of validation of psychiatric diagnoses. The final session explores how we might move from the descriptive to the etiologic in psychiatric diagnoses, the nature of progress in psychiatric research and the possible benefits of moving to a living document (or continuous improvement) model for psychiatric nosologic systems. The organization of the book—with its introduction and comments—well captures the dynamic cross-disciplinary interactions that characterize the best work in the philosophy of psychiatry.

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