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.

中文翻译：

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什么是精神障碍？以范例为中心的方法

'什么是精神障碍？是精神病学哲学的核心，对精神病学有重要的实际意义。我们不是从抽象的角度来解决问题，而是回顾了一系列示例——在 DSM-5 的工作期间和之后立即出现的问题案例的真实示例，目的是制定解决未来提案的实用指南。我们考虑以下情况：（1）有伤害但没有明显的功能障碍，（2）有功能障碍但没有明显的伤害，以及（3）可能存在功能障碍和/或伤害，但这由于各种原因存在争议。我们发现没有具体的标准来确定是否应该接受或拒绝新实体的未来提案；任何此类提案都需要根据其具体优点进行评估，并使用实际判断。尽管如此，还是出现了一些对该领域的建议。首先，虽然伤害对于定义精神障碍很有用，但一些提议的实体可能需要仔细考虑个体五。社会危害，以及社会适应。其次，虽然功能障碍有助于定义精神障碍，但该领域将受益于更明确的功能障碍指标。第三，将诊断有效性和临床实用性的证据纳入精神障碍的定义，并进一步阐明支持此类判断所需的数据类型和范围是有用的。