An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant be- havior (e.g., political, religious, or sexual) and conflicts that are primarily be- tween the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
The diagnosis of a mental disorder should have clinical utility: it should help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their pa- tients. However, the diagnosis of a mental disorder is not equivalent to a need for treat- ment. Need for treatment is a complex clinical decision that takes into consideration symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient’s distress (mental pain) associated with the symptom(s), disability related to the patient’s symptoms, risks and benefits of available treatments, and other factors (e.g., psychiatric symptoms complicating other illness). Clinicians may thus encounter individuals whose for treatment or care. The fact that some individuals do not show all symptoms indicative of a diagnosis should not be used to justify limiting their access to appropriate care.
Approaches to validating diagnostic criteria for discrete categorical mental disorders have included the following types of evidence: antecedent validators (similar genetic mark- ers, family traits, temperament, and environmental exposure), concurrent validators (simi— lar neural substrates, biomarkers, emotional and cognitive processing, and symptom similarity), and predictive validators (similar clinical course and treatment response). In
DSM-5, we recognize that the current diagnostic criteria for any single disorder will not nec- essarily identify a homogeneous group of patients who can be characterized reliably with all of these validators. Available evidence shows that these validators cross existing diagnostic boundaries but tend to congregate more frequently within and across adjacent DSM-S chap- ter groups. Until incontrovertible etiological or pathophysiological mechanisms are identi- fied to fully validate specific disorders or disorder spectra, the most important standard for the DSM-S disorder criteria will be their clinical utility for the assessment of clinical course and treatment response of individuals grouped by a given set of diagnostic criteria.
This definition of mental disorder was developed for clinical, public health, and re- search purposes. Additional information is usually required beyond that contained in the
DSM-5 diagnostic criteria in order to make legal judgments on such issues as criminal re- sponsibility, eligibility for disability compensation, and competency (see ”Cautionary
Statement for Forensic Use of DSM-5” elsewhere in this manual).
Use of the Manual 21
There have been substantial efforts by the DSM-5 Task Force and the World Health Orga- nization (WHO) to separate the concepts of mental disorder and disability (impairment in social, occupational, or other important areas of functioning). In the WHO system, the In- ternational Classification of Diseases (ICD) covers all diseases and disorders, while the In- ternational Classification of Functioning, Disability and Health (ICF) provides a separate classification of global disability. The WHO Disability Assessment Schedule (WHODAS) is based on the ICF and has proven useful as a standardized measure of disability for men- tal disorders. However, in the absence of clear biological markers or clinically useful mea- surements of severity for many mental disorders, it has not been possible to completely separate normal and pathological symptom expressions contained in diagnostic criteria.