What Should Count as a Mental Disorder in DSM-V?

If sick men fared just as well eating and drinking and living exactly as healthy men do . . . there would be little need for the science [of medicine].
attributed to Hippocrates

Well, while I’m here, I’ll do the work—and what’s the work? To ease the pain of living. . . .
Allen Ginsberg

What exactly is a “mental disorder”? For that matter, what criteria should determine whether any condition is a “disease” or a “disorder”? Is “disease” something like an oak tree—a physical object you can bump into or put your arms around? Or are terms like “disease” and “disorder” merely abstract, value-laden constructs, akin to “injustice” and “immorality”? Are categories of disease and disorder fundamentally different in psychiatry than in other medical specialties? And—by the way—how do the terms “disease,” “disorder,” “syndrome,” “malady,” “sickness,” and “illness” differ?

Anyone who believes there are easy or certain answers to these questions is either in touch with the Divine Mind, or out of touch with reality. To appreciate the complexity and ambiguity in this conceptual arena, consider this quote from the venerable Oxford Textbook of Philosophy and Psychiatry:



The term “mental illness” is probably best used for those disorders that are intuitively most like bodily illness (or disease) and, yet, mental rather than bodily. This of course implies everything that is built into the mind-brain problem!1(p11)

In a single sentence, we are already grappling with the terms “illness,” “disorder,” and “disease,” not to mention Cartesian psychology! And yet—daunting though these issues are—they are central to the practical task now before the DSM-V committees: figuring out what conditions ought to be included as psychiatric disorders.

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Clues to Role of Brain Development as Risk for Mental Disorders May Also Lead to Better Treatments

Increasing evidence points to links between the timing and growth rates of specific brain areas in the young brain and the likelihood of developing a wide range of mental disorders later in life, say researchers convened by the National Institute of Mental Health ( NIMH ), a part of the National Institutes of Health. Included among these mental disorders are autism, anxiety, bipolar disorder, eating disorders, substance abuse, and attention deficit hyperactivity disorder ( ADHD ).

"Most psychiatric disorders, including those with adult onset such as schizophrenia, are increasingly recognized as being neurodevelopmental in origin," says NIMH's Jay Giedd, MD. "A greater understanding of the specifics of brain development, and where the path of development goes awry in illnesses, may be a key factor in devising better therapies."

The scientists spoke today at a press conference during the American Psychiatric Association Annual Meeting being held here.

A twenty-year ongoing longitudinal neuroimaging project of healthy children and adolescents being conducted at NIMH's child psychiatry branch shows the relationship between dynamic brain changes and the emergence of several classes of psychiatric disorders during adolescence.

The data set, which tracks participants aged three to 30 years every two years, consists of more than 6,000 magnetic resonance imaging ( MRI ) scans from 2,000 subjects. About half are from typically developing subjects and half have disorders such as attention deficit hyperactivity disorder, and childhood-onset schizophrenia. "The large number of typically developing subjects serves not only to provide a yardstick from which to assess developmental deviations but also because understanding the timing, mechanisms, and influences of healthy brain development may illuminate paths to intervention in illness," says Giedd, who oversees the study.

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