[Do we know what a disorder is? Prospects of the DSM 5]

Abstract

Mental problems are generically called disorders. However, over half a century after they were first included in diagnostic manuals, and although the use of the term disorder has become consolidated in everyday life, it still stands out as an artificial construct that does not exist in nature itself. The article highlights the inconsistencies of the categorical and polythetic model implicit in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The contributions made by evolutionary psychopathology and advances in genetics are discussed and these two angles give rise to a new way of understanding mental disorders that calls for a deep transformation of the categorical model. Evolutionary psychopathology enables us to understand mental disorders that have their origins in adaptive behaviours, but which are ill-adjusted in the individual who has them. With the promising expectations deriving from studies based on a huge number of genetic variations, the field of genetics opens up the doors to a conceptualisation of disorders that is considerably different from the current model. As a result of all this, there appears to be a need to set out on the path towards a change of paradigm. The DSM 5, although perhaps still to an insufficient degree, seems to want to offer an answer to the inconsistencies of the present model. In this regard, the next edition of the DSM is due to incorporate dimensional scales and cross-sectional scales, without forsaking the categorical conceptualisation altogether.