Definition Of Mental Disorder Research Articles

Mental Health Acts - Perspectives from Mental Health and Law in Ireland and in Portugal.

Mental health legislation is a cornerstone to ensure that individuals with severe mental illness access proper care and treatment. Each country establishes their own legislation. We aimed to compare the Portuguese and Irish Mental Health Acts (MHAs). We reviewed the respective MHA and the literature. While the definition of mental disorder is similar in general, who, where, when and how one can be detained differ. Judges decide on detentions in Portugal, while consultant psychiatrists may do so in Ireland. Community-based compulsory treatment is possible and used in Portugal while it is not possible in Ireland. Pros and cons of each approach are discussed with a reflection on the protection of human rights. Further theoretical and empirical studies comparing systems in different jurisdictions would be helpful to deepen our understanding of the legislation and guide on how to better serve individuals with severe mental illness.

Reconsidering harm in psychiatric manuals within an explicationist framework.

The notion of harm has been a recurring and a significant notion in the characterization of mental disorder. It is present in eminent diagnostic manuals such as DSM and ICD, as well as in the discussion on mental disorders in philosophy of psychiatry. Recent demotion of harm in the definition of mental disorders in DSM-5 shows a general trend towards reducing the significance of harm when thinking about the nature of mental disorders. In this paper, we defend the relevance of the notion of harm in the characterization of mental disorder against some of these attacks. We approach this issue by using the method of conceptual explication pioneered by Rudolf Carnap. Within this framework, we argue that keeping the notion of harm not only helps to discriminate what is pathological from the nonpathological but also prevents potential misuses of psychiatric authority.

What is a mental disorder? An exemplar-focused approach.

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.

Dysfunction and the Definition of Mental Disorder in the DSM

One approach that has tried to define mental disorder is called "natural function objectivism." According to natural function objectivism, it is possible to base the demarcation between normal and pathological mental states using a theory of natural normal function. Although promising, this approach has faced decisive criticisms forcing the search for alternative theories. In this article, I want to argue that there is still hope for a definition of mental disorder based on the criterion of dysfunction if we rethink the value-freedom ideal usually associated with this notion. One theory of function that has received little attention in the debate about the definition of mental disorder is the causal role approach to function (CR), initially developed by Robert Cummins. CR has usually been rejected as the right theory of function to define mental disorder using a "dysfunction clause." This is because it was considered too dependent on human interests. In this article, I want to defend that CR should be amended rather than rejected. More precisely, my claim is that CR's relativity to human interests should be constrained rather than the whole theory dropped. My aim is to provide a framework for thinking about a notion of dysfunction that is both value-laden and sufficiently objective to provide a basis for distinguishing between healthy and pathological mental conditions, using Alexandrova's account of "social objectivity."

Towards a socially constructed and objective concept of mental disorder

In this paper, I argue for a new way to understand the integration of facts and values in the concept of mental disorder that has the potential to avoid the flaws of previous hybrid approaches. I import conceptual tools from the account of procedural objectivity defended by Helen Longino to resolve the controversy over the definition of mental disorder. My argument is threefold: I first sketch the history of the debate opposing objectivists and constructivists and focus on the criticisms that led to the emergence of the debate. Second, I offer a reconstruction of the “Natural Function Approach” (NFO) argument to make explicit an unsound assumption underlying this approach. The reconstruction will allow me to show that the NFO’s argument depends on the ideal of value-free science that I will criticize. Then I propose an alternative ideal for psychiatry: social objectivity. I argue that the concept of mental health should be seen as “socially objective” rather than value-free, moving the debate towards the social procedures by which the definition is produced rather than the normative and factual content of its definition.

Is the definition of mental disorder by intentionality valid?

Is the definition of mental disorder by intentionality valid?

The case for removing intellectual disability and autism from the Mental Health Act.

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La physiologie et le renouveau kraepelinien de la psychiatrie

The place of physiology in the Kraepelinian revival of psychiatry is central. Asserting that “psychiatry is a medical specialty”, the “neo-kraepelinian” creed already emphasized that the psychiatrist's attention must “particularly focus on the biological aspects of mental illness”. This is what the various definitions of mental disorder that can be found in the evolution of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have done. However, the DSM reliability project was found to be insufficient for the validity of the diagnoses. Thus a competing project has been developed: the project of criteria for research areas (RDoC), by the National Institute of Mental Health (NIMH). The confrontation between clinical and physiological is therefore inherent in the history of recent conceptions of psychiatry, and has been particularly present in the institutional structuring of French psychiatry between asylum doctor and hospital doctor.

Medical and mental disorder: Proposed definition and criteria

There was a need for a definition of mental disorder in the preparation of the Third Edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-III). Decisions had to be made on a variety of issues that seemed to us to relate to the fundamental question of the boundaries of the concept of mental disorder. Without some definition of mental disorder, there would be no explicit guiding principles that would help to determine which conditions should be included in the nomenclature, which excluded, and how conditions included should be defined. This article describes a definition of and criteria for medical disorders. The definition of mental disorder proposed here is merely a subset of the definition of medical disorder, it contributes to the continuing debate concerning the appropriateness of the medical model as applied to psychiatric disturbance. The proposed definition is: “A medical disorder is a relatively distinct condition resulting from an organismic dysfunction which in its fully developed or extreme form is directly and intrinsically associated with distress, disability, or certain other types of disadvantage. The disadvantage may be of a physical, perceptual, sexual, or interpersonal nature. Implicitly there is a call for action on the part of the person who has the condition, the medical or its allied professions, and society. A mental disorder is a medical disorder whose manifestations are primarily signs or symptoms of a psychological (behavioral) nature, or if physical, can be understood only using psychological concepts”. Operational criteria are proposed to provide sufficient evidence for both an organismic dysfunction and justification for societal recognition of the appropriateness of the sick role. A condition must meet all criteria to be considered a medical disorder. Each of the criteria follows with explication of key concepts.

Utjecaj Konvencije o pravima osoba s invaliditetom na kaznenopravni institut neubrojivosti

The paper analyses the influence of the Convention on the Rights of Persons with Disabilities upon the criminal status of one group of persons with disabilities, hence, persons suffering from mental disorders. Although there is no explicit mention of criminal responsibility in the Convention, some interpretations suggest that the provisions of the Convention request abolition of some criminal law mechanisms which would apply if the person accused of a crime suffered from a mental disorder. These mechanisms, as suggested by those interpretations, are contrary to the Convention’s provisions, in particular to articles 5 and 12. This paper thus examines whether article 12, which introduces significant novelties into the recognition of legal capacity for persons suffering from mental disorders, may also be extended to the criminal responsibility of those persons. Furthermore, the paper investigates whether the definition of insanity, based on the definition of mental disorders, is contrary to the requests of the Convention, especially to the provisions of article 5 on equality and non-discrimination.

Evolutionary psychiatry: Innovations and limits

In this paper, I explain why evolutionary psychiatry is not where the next revolution in psychiatry will come from. I will proceed as follows. Firstly, I will review some of the problems commonly attributed to current nosologies, more specifically to the DSM. One of these problems is the lack of a clear and consensual definition of mental disorder; I will then examine specific attempts to spell out such a definition that use the evolutionary framework. One definition that deserves particular attention (for a number of reasons that I will mention later), is one put forward by Jerome Wakefield. Despite my sympathy for his position, I must indicate a few reasons why I think his attempt might not be able to resolve the problems related to current nosologies. I suggest that it might be wiser for an evolutionary psychiatrist to adopt the more integrative framework of “treatable conditions”. As it is thought that an evolutionary approach can contribute to transforming the way we look at mental disorders, I will provide a brief sketch of the basic tenets of evolutionary psychology. The picture of the architecture of the human mind that emerges from evolutionary psychology is thought by some to be the crucial backdrop to identifying specific mental disorders and distinguishing them from normal conditions. I will also provide two examples of how evolutionary thinking is supposed to change our thinking about some disorders. Using the case of depression, I will then show what kind of problems evolutionary explanations of particular psychopathologies encounter. In conclusion, I will evaluate where evolutionary thinking leaves us in regard to what I identify as the main problems of our current nosologies. I’ll then argue that the prospects of evolutionary psychiatry are not good.

An Inconvenient Mirror: Do we already have the next Mental Health Act?

<p>The Government intends to replace the Mental Health Act 1983, and the most recent of its proposals were contained in the Draft Mental Health Bill published in June 2004.</p><p>The 1983 Act is now very different to the statute introduced at the end of 1982. Parliament and the courts have made a number of significant changes over the last 20-odd years, and they have brought us a lot closer to the next Mental Health Act than many people – and possibly even the Government – suppose. In fact, those changes may have brought us rather close to the Draft Mental Health Bill. That will be an uncomfortable thought for many people.</p><p>This paper will consider five key aspects of the Draft Mental Health Bill:</p><p>• the provisions dealing with risk and treatability;</p><p>• the notion of compulsion in the community;</p><p>• the status of the Code of Practice; and</p><p>• the abolition of the Approved Social Worker.</p><p>The paper will ask whether, because of the changes of the last two decades, the current Mental Health Act has already arrived at much the same point. In addition, the paper will consider the position of incapable patients. Although the Draft Bill contains precious few proposals about them, the paper will ask whether recent developments have made a broad definition of mental disorder all but essential.</p>

Beyond Dysfunction: Distress and the Distinction Between Deviance and Disorder

Beyond Dysfunction:Distress and the Distinction Between Deviance and Disorder Rachel Bingham (bio) and Mohammed Abouelleil Rashed (bio) Keywords Social deviance, mental disorder, critical psychiatry, DSM-5 Johanna Moncrieff’s and Dan Stein’s commentaries illuminate the complexity inherent in the question we pose in the original paper ‘Can Psychiatry Distinguish Social Deviance from Mental Disorder?’ So much difficulty abounds in addressing such a question: on one hand, there are the difficulties in defining mental disorder that many readers of this journal are familiar with. On the other, there is the critical stance held by some writers to the effect that psychiatry medicalizes human suffering, thus obscuring its moral, social, and political underpinnings (e.g., Rapley, Moncrieff, and Dillon 2011). Adherents of the seminal critique of Thomas Szasz question the very distinction between mental disorder and social deviance, and for them the question of how to delineate the proper domain of psychiatry is nonstarter. An essential discussion, before dismissing psychiatry outright, would consider what to say about those large swathes of humanity voluntarily seeking psychiatric help for their distress. But this is not the central concern of our paper, which does not commit to any strong claim about what or whom should be treated by psychiatrists. Rather, we are concerned to develop one recognized criterion for when people should not be treated by psychiatrists: namely, when their distress is solely the result of social deviance or conflict with society. Given the complexity of this topic which the commentaries highlight—and the potential for misunderstanding, which may explain some of our disagreement with Moncrieff in particular—our response partly clarifies our approach and thesis, and partly takes issue with specific points made by the commentators. Mental Disorder: Separating Empirical From Conceptual Considerations Let us begin by revisiting the conceptual basis of attributions of mental disorder. Criterion E is not, as we argued with Stein et al. (2010, 1765), conceptually necessary, but is of ethical and political importance given the historical context. Thus, notwithstanding the other criteria, a condition can only be considered for candidacy for mental disorder if “dysfunction” is present. What is a dysfunction? As Moncrieff puts it, there is a tautology in the definition of mental disorder where it is stated that a mental disorder reflects an “underlying psychobiological dysfunction” (Moncreiff 2014, 257). [End Page 267] Moncrieff argues that this is flawed because underlying processes have not been established, which renders the definition tantamount to saying that a dysfunction is a reflection of a dysfunction: a definition that adds nothing to our knowledge. Here Moncrieff follows Thomas Szasz in finding a lack of resemblance to physical disorder to be the primary problem with the concept of mental disorder (see Fulford et al. 2013).1 In pursuing this, the critical psychiatrist not only fails to see the complexity of the concept of physical disorder, but also commits the same error as the biological psychiatrist. The latter implies that an ever longer awaited complete neurochemistry of mental health conditions would solve the conceptual problems. The former—the critical psychiatrist—implies the converse; that the absence of proof for the “existence of separate and distinct foundational processes,” as Moncrieff (2014, XX) puts it, proves that mental health conditions are not disorders. As we have argued elsewhere, identifying the biological basis for a set of behaviors or symptoms does not in itself pick out what is pathological or disordered: for example, a complete description of the neurochemical states governing sexuality would not permit the inference that homosexuality is a disorder, any more than discovery of the neural correlates of falling in love or criminality would make these mental illnesses (Bingham and Banner 2012). Neurobiological changes—their presence or their absence—tells us about conditions when we find them by other means, but it does not tell us what is or is not a disorder. The same arguments could be run for underlying psychological processes. Consequently, emphasis on scientific progress or failure to progress in understanding the neurobiological correlates of mental health conditions does little to advance the conceptual debates, a point that may help to explain the impasse in the ongoing exchange between...

The global burden of mental and substance use disorders: changes in estimating burden between GBD1990 and GBD2010.

Background. The main aim of this paper is to compare and contrast the methodological approaches of the new Global Burden of Disease 2010 Study (GBD 2010) with the original study conducted for 1990 (GBD 1990), in terms of calculating burden for mental and substance use disorders. Methods. We reviewed the conceptual and methodological changes to GBD burden calculations in the GBD 2010 study, compared with previous studies. We then discuss the possible implications of these changes with respect to burden estimates for mental and substance use disorders. Results. It is not possible to compare burden estimates arising from the GBD 1990 study with the most recent burden estimates. There have been important advances in the categorisation and definition of mental disorders, and the input and computation of epidemiological models for disease distribution. There have also been major changes to conceptual and social value choices aimed at addressing concerns that arose following publication of earlier GBD studies. Conclusion. Advancements to the GBD conceptual framework and method of calculating burden estimates has led to more accurate and equitable consideration of the burden for mental and substance use disorders. Proposed annual updates of GBD estimates by the Institute of Health Metrics and Evaluation provide an opportunity to continue to advance the evidence base that underpins the quantification of disease burden.

DSM-5: Changes and Controversies: Table 1

A Brief History of DSMThe American Psychiatric Association's (APA) 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 2013a) represents the latest iteration of a document which has been shaped by social and scientific forces. DSMI (APA, 1952) represented APA's attempt improve on the diagnostic system of mental disorders contained in the World Health Organization's (WHO) International Classification of Diseases (ICD; see World Health Organization, 1948) which was, at that time, in its 6th revision (Grob, 1991). Based largely on War Department Technical Bulletin Medical 203, a classification system developed by the Surgeon General's Office under the leadership of William C. Menninger, DSMI reflected a psychodynamic orientation which asserted that the development and maintenance of mental disorders was explained by a person's biological, psychological, and environmental stressors (Clegg, 2012).Changes DSM-II (1968) were minimal and characterized by an increase in the number of disorders which some attributed the inclusion of milder forms of more serious mental conditions (Kawa & Giordano, 2012). Another change involved the slow movement away from a psychodynamic orientation (although most consider the DSM-II be largely grounded in that tradition), characterized by the removal of the term reaction from the definition of mental disorders (Clegg, 2012; Houts, 2000). Bigger changes, however, were on the horizon.DSM-III (1980), under the guidance of Dr. Robert Spitzer, contained 500 pages (an increase from 132 pages in DSM-II) and embodied significant changes in classifications and scientific notions about the etiology of mental disorders (Fischer, 20121). First, the manual's authors developed a criteria-based, classificatory approach diagnosis whereby one could determine the relative presence or absence of a set of specific psychiatric symptoms (Mayes & Horwitz, 2005). While some accused the new system of relying too heavily on a positivistic, research-based method of diagnosis for case formulation (McWilliams, 2013), others acknowledge the revision for its improvement in diagnostic clarity and reliability (Wilson, 1993). This move also represented a theoretical paradigm shiftfor DSM: from a predominantly psychodynamic a largely atheoretical approach. No longer relying on the presence of unobserved phenomena for the codification of mental disorders, the empirically-based system allowed an increasing number of practitioners whose training reflected an array of theoretical orientations use the manual (Neimeyer, 2013). This changed the focus of DSM from a manual of etiology (causes) a manual for diagnosis (Wilson, 1993).Another notable addition DSM-III was the introduction of the multi-axial system allowing the user compile a diagnostic profile based on: (Axis I) Diagnoses of clinical attention; (Axis II) Disorders of personality or intellectual ability; (Axis III) Medical and physical disorders; (Axis IV) Psychosocial and environmental problems; and (Axis V) A rating of highest adaptive functioning. According APA, this five-axis system was introduced to ensure that certain information that may be of value in planning and treatment and predicting outcomes for each individual is recorded (APA, 1980, p. 9).Subsequent revisions focused predominantly on refining the operationalization of disorders, updating statistical prevalence and incidence of disorders, and introducing and deleting new diagnoses based on prevailing clinical evidence. DSM-III-R (1987) was 594 pages in length and saw the removal of egodystonic homosexuality, the last remnant of a homosexualityrelated mental health disorder (Fischer, 2012). A notable addition DSM-IV (under the leadership of Dr. Allen Frances in 1994) involved the inclusion of a clinical significance standard many diagnostic criteria sets (i.e., the disorder must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning) (APA, 1994). …

Mental Disorder or “Normal Life Variation”? Why It Matters

Diagnostic and Statistical Manual of Mental Disorders, fifth edition ( DSM-5) promises a refined definition of mental disorder, which is tantamount to acknowledging that prior DSM definitions have failed to clarify what mental disorder is and why a person should be considered mentally disordered. Since the DSM promotes the position that what is actually the matter, as in medicine generally, is an impersonal, anonymous affliction, the universe of considerations that goes along with thinking about an individual as a person becomes ancillary at best. Incorrect diagnosis of mental disorder present is a form of person negation, with unlimited possible iatrogenic consequences. The new definition, like the old, is simply a form of double-talk. The American Psychiatric Association continues to be unconcerned with the practical consequences of person negation.

The DSM-5 controversies: How should psychologists respond?

The American Psychiatric Association (APA) published DSM-5 in May 2013. The revision process was fraught with controversy. In the first section of this article, we briefly summarise the controversies related to the actions of the APA and the Task Force responsible for the revision process. These include allegations of secrecy, accusations of conflicts of interest, apprehension over a promised paradigm shift, concerns about the definition of mental disorder, charges of medicalizing normality, and claims of poor methodology. In the second section, we briefly summarise the controversies related to some of the revisions to the DSM-5 disorders and diagnostic criteria. In the third section, we argue that DSM-5 development was unnecessarily contentious for reasons that could have been foreseen and prevented. Because incremental updates to the DSM-5 are anticipated in the near future (American Psychiatric Association, 2010, APA modifies DSM naming convention to reflect publication changes, Washington, DC: Author), we propose that psychologists external to the revision process should use their unique expertise to assist in resolving the controversies that have beset the DSM-5 and thereby facilitate a less contentious development of the next iteration of the DSM.Keywords: DSM-5, controversies, psychologistsThe American Psychiatric Association (APA) published the DSM-5 in May 2013 (APA, 2013). The revision process was fraught with controversy. Our purpose is to summarise those controversies and then to examine how psychologists might respond to them. We reviewed the literature using PsycINFO, PsychiatryOnline, Medline, and Google Scholar databases using DSM V, DSM-V, DSM 5, and DSM-5 as search terms, through December 2012. Two major areas of controversy were identified. The first was the way the APA and DSM-5 Task Force conducted the revision process. The second related to some of the proposed revisions to the disorders and diagnostic criteria that were posted on the APA's website, DSM-5 Development (APA, 2010b; the proposed disorders, criteria sets, and rationales were removed from the website in 2012.) The search yielded a plethora of articles. Consequently, we reviewed only as many articles as necessary to provide an awareness of the main controversies and to provide a context for understanding why we believe that psychologists should respond to them.BackgroundThe DSM-5 Task Force was responsible for the revision process. In 2006, David Kupfer, MD, was appointed Chair and Darrel Regier, MD, MPH, was appointed Vice-Chair. Members of 13 Work Groups were announced in 2008. The Task Force developed four guiding principles (Kupfer, Regier, & KA¼hl, 2008). The first was that proposals be based on empirical evidence. The second was that continuity with previous versions of DSM be maintained when possible. The third, and most controversial, was the removal of all limitations on the amount of change that could occur. The fourth was that DSM-5 be a living document that could be updated periodically. The APA (2010a) replaced the conventional Roman numeral with an Arabic numeral to permit incremental updates using decimals (e.g., DSM-5, 5.1, 5.2).Controversies Related to the Task ForceThe issue of secrecy is one of the most significant controversies surrounding the development of the DSM-5. Robert Spitzer, MD (2008), Chair of the DSM-III and DSM-III-R Task Forces, reported that Regier had denied his request for the minutes of Task Force meetings in order to maintain DSM-5 confidentiality. Spitzer (2008) was incredulous. He reported that all Task Force and Work Group members were required to sign an acceptance form that prevented them from discussing their work publicly. Spitzer said the confidentiality agreement was unprecedented in the development of prior DSMs. He argued that the development of DSM-5 in secrecy indicated a failure by the Task Force to understand the necessity for an open and transparent revision process (Spitzer, 2008). …

The DSM-5 definition of mental disorder

The DSM-5 definition of mental disorder

1638 – Prolonged hospital admissions of patients with borderline personality disorder in the context of the new legislation in england and wales - patients’ view

Introduction In 2007 the Mental Health Act in England and Wales was amended and the definition of Mental Disorder was broadened. This change affected people with Personality Disorders who now can be admitted for hospital treatment without consent, often for prolonged period of time. Objectives This poster reviews clinicians’ attitudes towards the new legislation and its consequences and also presents the research on the different perspectives about the new law. Aims To review clinicians’ attitudes with regard to interfaces between Personality Disorders and the new law. Methods Use of the specifically designed questionnaire for clinicians providing hospital care for patients with Borderline Personality Disorders. MEDLINE and PsycINFO databases were also searched for all English-language articles published between 2008 and 2012 containing the keywords “rsonality Disorder”, “Mental Health Act” and “clinicians view on compulsory treatment of persons with Borderline Personality Disorder”. Additional key articles published before 2008 were reviewed. The most relevant articles were selected for the review. Results and conclusions There is still no common consensus in regard to the benefit of compulsory hospital admission of persons with Borderline Personality Disorders. Results from questionnaires are under review.

2176 – Prolonged hospital admissions of patients with borderline personality disorder in the context of the new legislation in england and wales -Clinicians’ view

In 2007 the Mental Health Act in England and Wales was amended and the definition of Mental Disorder was broadened. This change affected people with Personality Disorders who now can be admitted for hospital treatment without consent, often for prolonged period of time. This poster reviews clinicians’ attitudes towards the new legislation and its consequences and also presents the research on the different perspectives about the new law. To review clinicians’ attitudes with regard to interfaces between Personality Disorders and the new law. Use of the specifically designed questionnaire for clinicians providing hospital care for patients with Borderline Personality Disorders. MEDLINE and PsycINFO databases were also searched for all English-language articles published between 2008 and 2012 containing the keywords “rsonality Disorder”, “Mental Health Act” and “clinicians view on compulsory treatment of persons with Borderline Personality Disorder”. Additional key articles published before 2008 were reviewed. The most relevant articles were selected for the review. There is still no common consensus in regard to the benefit of compulsory hospital admission of persons with Borderline Personality Disorders. Results from questionnaires are under review.