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？”这个问题是精神病学哲学的核心，对精神病学分类学具有至关重要的实际意义。我们不是从抽象的角度来解决问题，而是回顾了一系列范例——DSM-5 工作期间和之后出现的问题案例的真实例子，目的是为解决未来的提案制定实用指南。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，（3）可能有功能障碍和/或伤害，但由于各种原因存在争议。我们没有找到具体标准来确定未来对新实体的提议是否应该被接受或拒绝；任何此类提案都需要根据其具体优点并运用实际判断进行评估。尽管如此，还是出现了对该领域的一些建议。首先，虽然伤害对于定义精神障碍很有用，但一些拟议的实体可能需要仔细考虑个人与社会伤害以及社会适应。其次，虽然功能障碍对于定义精神障碍很有用，但该领域将受益于更明确定义的功能障碍指标。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中，并进一步澄清支持此类判断所需的数据类型和范围将是有用的。