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.

scholarly journals Understanding the DSM-5: stasis and change

2017 ◽  
Vol 29 (1) ◽  
pp. 49-65 ◽  
Author(s):  
Rachel Cooper
Keyword(s):  
Mental Disorder ◽  
Conceptual Framework ◽  
Diagnostic Criteria ◽  
Historical Development ◽  
Conceptual Level ◽  
Dsm 5 ◽  
Dsm Iv ◽  
Definition Of ◽  
The Way

This paper aims to understand the DSM-5 through situating it within the context of the historical development of the DSM series. When one looks at the sets of diagnostic criteria, the DSM-5 is strikingly similar to the DSM-IV. I argue that at this level the DSM has become ‘locked-in’ and difficult to change. At the same time, at the structural, or conceptual, level there have been radical changes, for example in the definition of ‘mental disorder’, in the role of theory and of values, and in the abandonment of the multiaxial approach to diagnosis. The way that the DSM-5 was constructed means that the overall conceptual framework of the classification only barely constrains the sets of diagnostic criteria it contains.

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

2010 ◽  
Vol 40 (11) ◽  
pp. 1759-1765 ◽  
Author(s):  
D. J. Stein ◽  
K. A. Phillips ◽  
D. Bolton ◽  
K. W. M. Fulford ◽  
J. Z. Sadler ◽  
...  
Keyword(s):  
Psychiatric Disorder ◽  
Mental Disorder ◽  
Additional Work ◽  
Dsm V ◽  
Dsm Iv ◽  
Definition Of ◽  
Over Time

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.

To ID or Not to ID? Changes in Classification Rates of Intellectual Disability Using DSM-5

2014 ◽  
Vol 52 (3) ◽  
pp. 165-174 ◽  
Author(s):  
Aimilia Papazoglou ◽  
Lisa A. Jacobson ◽  
Marie McCabe ◽  
Walter Kaufmann ◽  
T. Andrew Zabel
Keyword(s):  
Intellectual Disability ◽  
Clinical Judgment ◽  
Assessment System ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Adaptive Behavior Assessment System ◽  
Dsm Iv ◽  
Definition Of ◽  
Adaptive Skill

Abstract The Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) diagnostic criteria for intellectual disability (ID) include a change to the definition of adaptive impairment. New criteria require impairment in one adaptive domain rather than two or more skill areas. The authors examined the diagnostic implications of using a popular adaptive skill inventory, the Adaptive Behavior Assessment System–Second Edition, with 884 clinically referred children (ages 6–16). One hundred sixty-six children met DSM-IV-TR criteria for ID; significantly fewer (n  =  151, p  =  .001) met ID criteria under DSM-5 (9% decrease). Implementation of DSM-5 criteria for ID may substantively change the rate of ID diagnosis. These findings highlight the need for a combination of psychometric assessment and clinical judgment when implementing the adaptive deficits component of the DSM-5 criteria for ID diagnosis.

scholarly journals The Lay Concept of Conduct Disorder: Do Nonprofessionals Use Syndromal Symptoms or Internal Dysfunction to Distinguish Disorder from Delinquency?

2006 ◽  
Vol 51 (4) ◽  
pp. 210-217 ◽  
Author(s):  
Jerome C Wakefield ◽  
Stuart A Kirk ◽  
Kathleen J Pottick ◽  
Derek K Hsieh ◽  
Xin Tian
Keyword(s):  
Conduct Disorder ◽  
Mental Disorder ◽  
Social Workers ◽  
Diagnostic Criteria ◽  
False Positives ◽  
Shared Understanding ◽  
Clinical Vignettes ◽  
Dsm Iv ◽  
Definition Of ◽  
Professional Judgments

Background: Conduct disorder (CD) must be distinguished from nondisordered delinquent behaviour to avoid false positives, especially when diagnosing youth from difficult environments. However, the nature of this distinction remains controversial. The DSM-IV observes that its own syndromal CD diagnostic criteria conflict with its definition of mental disorder, which requires that symptoms be considered a manifestation of internal dysfunction to warrant disorder diagnosis. Previous research indicates that professional judgments tend to be guided by the dysfunction requirement, not syndromal symptoms alone. However, there are almost no data on lay conceptualizations. Thus it remains unknown whether judgments about CD are anchored in a broadly shared understanding of mental disorder that provides a basis for professional–lay consensus. Objective: The present study tests which conception of CD, syndromal-symptoms or dysfunction-requirement, corresponds most closely to lay judgments of disorder or nondisorder and compares lay and professional judgments. We hypothesized that lay disorder judgments, like professional judgments, tend to presuppose the dysfunction requirement. Method: Three lay samples (nonclinical social workers, nonpsychiatric nurses, and undergraduates) rated their agreement that youths described in clinical vignettes have a mental disorder. All vignettes satisfied DSM-IV CD diagnostic criteria. Vignettes were varied to present syndromal symptoms only, symptoms suggesting internal dysfunction, and symptoms resulting from reactions to negative circumstances, without dysfunction. Results: All lay samples attributed disorder more often to youths whose symptoms suggested internal dysfunction than to youths with similar symptoms but without a likely dysfunction. Conclusions: The dysfunction requirement appears to reflect a widely shared lay and professional concept of disorder.

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.

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.

Diagnostic and Statistical Manual (DSM)

2014 ◽  
Author(s):  
Thomas A. Widiger ◽  
Whitney L. Gore
Keyword(s):  
Empirical Support ◽  
Dimensional Model ◽  
Fourth Edition ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
History Of ◽  
Dsm Iv ◽  
Definition Of

This chapter provides a discussion of the American Psychiatric Association’s classification of mental disorders (DSM-I through DSM-5), with a particular emphasis on mood disorders and their classification and diagnosis. It begins with the rationale for having an official, authoritative diagnostic manual and then traces the history of the development of the first edition through the fourth edition (DSM-IV-TR, 2000). The authors then discuss fundamental issues concerning the fifth edition (DSM-5, 2013), including the definition of mental disorder, the empirical support for proposed revisions, the shift toward a dimensional model of classification, and the shift toward a neurobiologically-based classification.

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