Problems with the DSM-IV definition of mental
disorder:
(1) It is not evident whether “distress” (i.e., a painful
symptom) must be experienced as a direct result of the
condition, or can be caused by situations that are
secondary to the condition, such as social disapproval
or rejection due to one’s non-conformity to societal
norms
- the mere association of a particular behaviour with
distress should not be sufficient to diagnose that
behaviour a mental disorder
- distress might be associated indirectly with a
particular behaviour simply in response to having
one’s desired manner of behaving thwarted
(2) There are no object guidelines for assessing
the presence of “clinically significant” distress.
-As noted in the DSM-IV, such an assessment
represents an “inherently difficult clinical
judgment,” and “reliance on information from
family members and other third parties (in
addition to the individual) …is often necessary.”
- A clarity with regards to the issue of
what counts as “clinically significant distress”
leaves interpretation open to the bias of the
particular clinician involved
- This is particularly important because there is
sometimes a lack attention paid to self-reports of
distress, and instead, diagnosis is primarily based on
third party (i.e., family, friends, colleagues) reports
- Third parties might report the “patient” is
experiencing clinically significant distress, when in
reality no such distress exists and, rather, it is those
third party individuals that are distressed by the
patient’s behaviour
(3) It is unclear against what standard “disability”
(i.e, impairment in one or more important areas of
functioning) should assessed
- In the absence of such guidelines, interpreting
“disability” becomes a subjective judgment
(4) It is unclear what counts as “an important
loss of freedom”
- once again this opens up interpretation to the
particular biases of the clinician involved
(5) Behaviours that might be considered “mental
disorders” in Western culture, would simply be
perceived expectable or culturally sanctioned response
to a particular event
- Ritualized fellatio of men by boys in Sambian culture
(New Guinea)
(6) The interpretation of “dysfunction” is open to
interpretation given that no definition is provided
in the DSM-IV
- Some clinicians have argued that “dysfunction” refers
to the “failure of some mechanism in a person to
perform a natural function for which the mechanism
was designed by natural selection.”
- This notion of dysfunction is flawed
- Just because some genetically-based trait was
designed (i.e., produced by natural selection) for a
particular function (i.e., an adaptive response to some
environmental problem) does not mean that it cannot
be co-opted in the present to serve some potentially
adaptive function (or neutral role) that it was not
specifically designed by natural selection to perform
- Our mouths evolved to masticate food, but past
selection for this adaptive function did not prohibit
the masticatory structure from being co-opted for
other adaptive functions like language production
or neutral roles such as oral sex
-A lack of some linear relationship between an
“internal mechanism” and “past design” cannot be
taken as evidence that the mechanism is dysfunctional
(7) The DSM-IV provides no definition of what counts
as “deviant behaviour”
The Penguin Dictionary of Psychology definition:
“Generally, any pattern of behavior that is markedly
different from the accepted standards within a society.
The connotation is always that moral or ethical issues
are involved and, in use, the term is typically qualified
to note the specific form, such as sexual deviance.”
- This raises the possibility that some of the
conditions described in the DSM-IV are deviant
(i.e., morally and ethically questionable by certain
segments of society), but they are not representative
of a “disorder”