Disorder as harmful dysfunction: a conceptual critique of DSM-III-R's definition of mental disorder

Psychol Rev. 1992 Apr;99(2):232-47. doi: 10.1037/0033-295x.99.2.232.


The Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) operationally defines disorder essentially as "statistically unexpectable distress or disability." This definition is an attempt to operationalize 2 basic principles: that a disorder is harmful and that a disorder is a dysfunction (i.e., an inability of some internal mechanism to perform its natural function). However, the definition fails to capture the idea of "dysfunction" and so fails to validly distinguish disorders from nondisorders, leading to invalidities in many of DSM-III-R's specific diagnostic criteria. These problems with validity are traced to DSM-III-R's strategies for increasing reliability.

Publication types

  • Review

MeSH terms

  • Humans
  • Mental Disorders / classification
  • Mental Disorders / diagnosis*
  • Mental Disorders / psychology
  • Neurocognitive Disorders / classification
  • Neurocognitive Disorders / diagnosis*
  • Neurocognitive Disorders / psychology
  • Psychiatric Status Rating Scales / statistics & numerical data*
  • Psychometrics
  • Reproducibility of Results