Psychological Medicine


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

D. J. Steina1 c1, K. A. Phillipsa2, D. Boltona3, K. W. M. Fulforda4, J. Z. Sadlera5 and K. S. Kendlera6

a1 Department of Psychiatry, University of Cape Town, South Africa

a2 Department of Psychiatry and Human Behavior, Brown University, USA

a3 Psychology Department, Institute of Psychiatry, King's College London, UK

a4 Departments of Philosophy and Psychiatry, Oxford University, UK

a5 Department of Psychiatry, University of Texas Southwestern, USA

a6 Department of Psychiatry, Medical College of Virginia, USA

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.

(Received September 15 2009)

(Revised November 23 2009)

(Accepted November 24 2009)

(Online publication January 20 2010)


c1 Address for correspondence: Professor D. J. Stein, UCT Department of Psychiatry, Groote Schuur Hospital J-2, Anzio Rd, Observatory 7925, Cape Town, South Africa. (Email: