Mental disorder: Are we moving away from distress and disability?

J Eval Clin Pract. 2018 Oct;24(5):973-977. doi: 10.1111/jep.12871. Epub 2018 Jan 11.


The first time that formally a definition of mental disorder was presented was in DSM-III. This resulted from a complex conceptual analysis carried out by Spitzer, chair of the committee on nomenclature and statistics. The criteria of harm (distress-disability) arise as main defining characteristics for mental illness, being added that "there is an inference" that there is a dysfunction. The distress-disability model was later developed by Wakefield. This author argued that in a medical or psychiatric disorder there had to be a dysfunctional component (value free) and another one of harm (value laden). In this article, we intend to review the emergence and evolution of the definition of mental disorder and the importance that the criteria of distress and disability always had in this definition. This happened until the advent of DSM-5 when these criteria came to play a secondary role.

Keywords: DSM-5; classification; disability; distress; dysfunction; epistemology; harm; psychiatry.

MeSH terms

  • Cognition
  • Diagnostic and Statistical Manual of Mental Disorders
  • Health Status
  • Humans
  • Knowledge
  • Mental Disorders / classification*
  • Philosophy, Medical
  • Psychiatry* / ethics
  • Psychiatry* / trends
  • Terminology as Topic