Diagnosing the Diagnostic and Statistical Manual of Mental Disorders (Karnac, 2014) evaluates the latest edition of the D.S.M.The publication of D.S.M-5 in 2013 brought many changes. Diagnosing the Diagnostic and Statistical Manual of Mental Disorders asks whether the D.S.M.-5 classifies the right people in the right way. It is aimed at patients, mental health professionals, and academics with an interest in mental health. Issues addressed include: How is the (...) D.S.M. affected by financial links with the pharmaceutical industry? To what extent were and should patients involved in revising the classification? How are diagnoses added to the D.S.M.? Does medicalization threaten the idea that anyone is normal? What happens when changes to diagnostic criteria mean that people lose their diagnoses? How important will the D.S.M. be in the future? (shrink)

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and (...) also consider whether mental disorders fall into natural kinds. The second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence (...) on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria. (shrink)

이 연구는 정신질환에 대한 기존의 정의를 개괄적으로 검토하고 DSM-5의 정신질환 정의를 고찰함으로써, DSM의 정의가 정상과 이상 사이의 경계 세우기라는 목적을 제대로 구현하지 못함을 보여주고, 정신질환의 정의에 관한 논의의 함의를 제시한다. 프랜시스와 필립스의 연구는 정신질환의 정의에 관련된 논의가 다양한 존재론적, 인식론적 기반 위에서 개진되었음을 알려준다. 기존의 논의는 크게 실재론적 태도와 정신질환 개념이 자의적이라는 구성주의적 태도로 나뉜다. DSM-5는 실재론적 입장을 견지하고 있으나, 진단에 가치적 개념을 포함하고 있고 실질적인 객관적 지표가 없다는 문제점이 있다. DSM-III편집의 책임자인 스피처의 정신질환 정의 또한 같은 문제를 내포한다. DSM-5는 (...) 통일된 판단만을 보장할 뿐 정상과 이상 사이의 경계 세우기라는 기능을 제대로 수행하지 못한다. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders contains the official diagnostic criteria for recognized mental illnesses. Some have asserted that DSM revisions have caused the boundaries of specific disorders to expand to include more behaviors, but no previous research has examined if such expansion is isolated or endemic. The current research consisted of an exploration of revisions to diagnostic criteria for 81 disorders. Each change between editions of the DSM (...) was conceptually analyzed as making the disorder more exclusive or more inclusive in terms of the number of people who could theoretically meet the criteria. Results indicated that 63% of disorders moved toward inclusivity, that each edition of the DSM moved toward inclusivity, and that most types of revisions increase inclusivity. (shrink)

This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice” and mental disorder concepts in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition—Text Revision, the author summarizes three different cases from the literature (...) that illustrate the problem of the vice–mental disorder relationship. Four general aspects of the conceptual issues are presented to frame the discussion, and general questions in a range of domains are posed for commentators. (shrink)

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of (...) mental disorder to better understand what necessary criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it. (shrink)

The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at (...) all. In this paper, we focus on the harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In this respect, we briefly examine the two components of harm, distress and disability, and then trace a distinction between mental disorder tokens and mental disorder types. Second, we argue that the decision not to regard the harm requirement as a necessary criterion for mental disorder is tenable for a number of practical and theoretical reasons, some pertaining to conceptual issues surrounding the two components of harm and others pertaining to the problem of false negatives and the status of psychiatry vis-à-vis somatic medicine. However, we believe that the harm requirement can be maintained among the specific diagnostic criteria of certain individual mental disorders. More precisely, we argue that insofar as the harm requirement is needed among the specific diagnostic criteria of certain individual mental disorders, it should be unpacked and clarified. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 (...) a mental disorder is defined as a syndrome that reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing (...) to autobiographies and memoirs written by people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

This dissertation examines psychiatry from a philosophy of science perspective, focusing on issues of realism and classification. Questions addressed in the dissertation include: What evidence is there for the reality of mental disorders? Are any mental disorders natural kinds? When are disease explanations of abnormality warranted? How should mental disorders be classified? -/- In addressing issues concerning the reality of mental disorders, I draw on the accounts of realism defended by Ian Hacking (...) and William Wimsatt, arguing that biological research on mental disorders supports the inference that some mental disorders (e.g., schizophrenia, mood disorders, and anxiety disorders) are real theoretical entities, and that the evidence supporting this inference is causal and abductive. In explicating the nature of such entities, I argue that real mental disorders are natural kinds insofar as they are natural classes of abnormal behavior whose members share the same causal structure. I present this position in terms of Richard Boyd’s homeostatic cluster property theory of natural kinds, and argue that this perspective reveals limitations of Hacking’s account on the looping effects of human kinds, which suggests that the objects classified by psychiatrists are unstable entities. I subsequently argue that a subset of mental disorders (e.g., schizophrenia and Down syndrome) are mental illnesses insofar as they are disorders caused by a dysfunctional biological process that leads to harmful consequences for individuals. I present this analysis against Thomas Szasz’s argument that mental illness is a myth. -/- In addressing issues of psychiatric classification, my analysis focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which has been published regularly by the American Psychiatric Association since 1952, and is currently in its fourth edition. After examining the history of DSM in the twentieth century, and in particular, DSM’s shift to an atheoretical and purely descriptive system in the 1980s, I consider the relative merits of descriptive versus causal systems of classification. Drawing on Carl Hempel’s analysis of taxonomic systems in psychiatry, I argue that a causal classification system would provide a superior approach to psychiatric classification than the descriptive system currently favored by DSM. (shrink)

The stated purpose of the Diagnostic and Statistical Manual of Mental Disorders is to classify mental disorders. However, no tenable operational definition of mental disorder is offered in the manual. This leaves the possibility open that the behaviors labeled as disordered in the DSM are not members of a valid category. Attempts to define mental illness fall into the category of essentialist or relativist based, respectively, on the acceptance or denial (...) of the existence of a defining biological attribute that all mental disorders possess. However, the disorders in the DSM cannot be accounted for by either of these approaches making it unlikely that they represent a single valid concept. Simultaneous inclusion of brain illnesses and normal behaviors in the DSM are a likely explanation for the disparate nature of DSM disorders. (shrink)

This thesis investigates the nature of psychiatric disorders, and to what extent they can form a basis for classification, explanation, and treatment interventions. These questions are important in the light of the “crisis of validity” in psychiatry, according to which current diagnostic categories do not pick out real disorders. I address the questions by defending an account of psychiatric disorders that can better accommodate social aspects and non-epistemic values than the symptom-based model of the Diagnostic (...) and Statistical Manual of Mental Disorders (DSM) and the brain disease model of the biomedical approach, including the Research Domain Criteria (RDoC). I concentrate on three ways that psychiatric disorders can differ from prototypical natural kinds, such as biological species and chemical elements. First, the concept of psychiatric disorder or mental disorder is partly value-laden and cannot be defined based only on scientific facts. Second, the objects of psychiatric classifications are interactive human kinds because people with disorders respond to their classifications through looping effects. Third, sociocultural factors can shape disorders in complex ways, which is indicated by their cross-cultural variation. I argue that these challenges can be overcome with a pluralistic explanatory account that grants an explicit role to value-sensitive considerations and social scientific research. Based on this, I argue that particular disorders can in principle support inductive inferences. ------------------------------------------------------------------------------------------ My key argument is that although whether a condition is considered pathological is partly a value-laden question, this does not rule out a realist account of particular psychiatric disorders as homeostatic property cluster kinds (HPC). I assert that causal mechanisms responsible for psychiatric kinds can be understood non-metaphysically based on the contrastive-counterfactual and interventionist theories of explanation. An advantage of this account is that it can address the concern that psychiatric explanations require one to relate heterogeneous causal factors on different levels, such as genetic, neurological, psychological, and social. My novel argument is that mechanistic explanations of scientific kinds have applicability domains over which they account for specific aspects of kinds and warrant inductive inferences. That is, identifying the applicability domain of an explanation spells out the conditions under which the explanation is expected to be reliable and when it can break down. This helps to understand how different discipline approaches, including social and cultural ones, can be complementary and make an explanation of a psychiatric kind more reliable. On the other hand, the account also shows how the complex nature of psychiatric kinds can license re-classifications for different epistemic and non-epistemic purposes. Finally, in the light of the social implications of psychiatric classifications, I suggest a value-sensitive or ameliorative approach to engineering the concept of psychiatric disorder. In conclusion, my account shows that research on the social and cultural factors that shape psychiatric disorders, and weighing the non-epistemic values that influence classificatory practices, can and should inform classificatory choices as well as policy and treatment interventions. (shrink)

Extensive and diverse conceptual work towards developing a definition of ‘mental disorder’ was motivated by the declassification of homosexuality from the Diagnostic and Statistical Manual in 1973. This highly politicised event was understood as a call for psychiatry to provide assurances against further misclassification on the basis of discrimination or socio-political deviance. Today, if a definition of mental disorder fails to exclude homosexuality, then it fails to provide this safeguard against potential abuses and therefore fails (...) to do an important part of the work it was intended to do. We argue that fact-based definitions of mental disorder, relying on scientific theory, fail to offer a robust definition of mental disorder that excludes homosexuality. Definitions of mental disorder based on values do not fare better: these definitions are silent on questions about the diagnostic status of individuals in oppressive societies and over-inclusive of mental or behavioural states that happen to be negatively valued in the individual's social context. We consider the latest definition proposed for the Diagnostic and Statistical Manual-5 in light of these observations. We argue that definition fails to improve on these earlier deficiencies. Its inclusion in the manual may offer false reassurance against repetition of past misclassifications. We conclude with a provocation that if candidate definitions of mental disorder are unable to exclude homosexuality, it might perhaps be preferable not to attempt a definition at all. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Close Enemies: The Relationship of Psychiatry and Psychology in the Assessment of Mental DisordersPhilippe Le Moigne, PhDAs Peter Zachar rightly points out in his comment, the assessment of mental disorders underwent new developments with the release of the Diagnostic and Statistical Manual of Mental Disorders-V in 2013 (American Psychiatric Association, 2013). Whereas in 1980, the manual had been thought of (...) in a rigorously categorical way, on the basis of distinct and closed syndromic entities, this new version advocated the development of a radically dimensionalist approach, with the diagnosis aiming this time to restore the whole symptomatological picture of the patient on a spectrum of ratings are supposed to cover the entirety of psychiatric semiology (American Psychiatric Association, 2013).For its part, my article aimed to show how standardized assessment, guided by the return of psychiatry’s authority and the assertion of its legitimacy in the diagnostic field, gave the ascendancy in the 1980s to the classificatory tradition and thus to the categorical model, to the detriment of personality approach and test psychology which offered a competing solution here. This perspective, historically dated, may have led the reader to think that there is an antagonism that cannot be overcome here. Rather, it should be seen as a form of structuring opposition, or even a “complementarity inscribed in rivalry,” between psychiatry and psychology, which is naturally susceptible to change over time.Indeed, the reversal operated by the Diagnostic and Statistical Manual of Mental Disorders-V is not total because it cannot be total. The defense of the dimensionalist approach, dear to the psychological testing tradition, was intended here to allow the identification of co-morbidities, present in most patients but poorly apprehended by the categorical approach, and to open up diagnosis to prevention by screening for minor manifestations of psychopathology when they suggest the [End Page 259] development of a manifest episode of the disease in the more or less long term. The risk here is that we end up with overdiagnosis and thus an over-representation of false positives (Wakefield, 2015). In other words, this type of approach does not escape the obligation to determine threshold scores, likely to indicate the lower limit of the disorder, and thus to resort to a categorical approach. There is a first affinity between the two perspectives which obeys, beyond the divergences in principle, a technical requirement.But the two approaches have even more in common when we look at their epistemological background: they share the idea that the representation and the intervention on mental disorder, to use Ian Hacking’s expression (1983), must be based on the model proposed by the physical and natural sciences. And as Greta Kaluzeviciute aptly points out in her comment, this orientation leads to the idea of measuring mental disorder in particular to conduct elaborate quantification operations to determine, for example, whether two entities are statistically distinct or whether a drug has a significant effect on the evolution of a pathology.This is in fact an old question that can be formulated as follows, to use the expression of the psychometrician Joel Michell (1999): are psychological dimensions metric? In other words, if we want to apply the language of numbers to mental disorders, they must share its properties, two of which seem essential: it must be possible to establish that each mental disorder, in the same way as qualities attributable to length for example, has a zero and can be divided by means of gradients (or degrees of intensity) whose interval is constant (Le Moigne, 2018; Michell, 1999). For lack of space, let us only address the second condition. This one has already been denied by many, starting with Bergson at the end of the nineteenth century (1889). He does not believe in the quantification of psychological expressions, starting with sensations. What is the common point, he wrote, between the feeling of a mild pain, as one feels a stiffness, and the sensation of a needle being hammered into your flesh? For him, one and the other of these intensities are incomparable, so that they do not belong to a similar register of sensations that one could stage from a 0 toward a... (shrink)

The development and publication of Diagnostic and Statistical Manual of Mental Disorders, fifth edition produced a peak in mainstream media interest in psychiatry, and a large and generally critical set of scientific commentaries. The coverage has focused mainly on the expansion of some categories, and loosening of some criteria, which together may lead to more people receiving diagnoses, and accompanying accusations of the medicalisation of normal living. Instructions given to members of DSM-5 work groups appear (...) to have encouraged this.1 This has not been the only source of disquiet. The influence of the pharmaceutical industry on the members of the appointees to DSM diagnostic work groups, which constructed the new rubrics, has caused concern,2 as remuneration and insurance coverage in the USA depends partly on DSM diagnosis, and the pharmaceutical industry has been accused of encouraging the development of new diagnoses as a way to increase profitability.3 Societal impact has been an explicit part of the development of DSM-5, as outlined in the article in this issue.4 Reasons for decisions by DSM-5 workgroups have included enabling sufferers to receive treatment which would not be available without a DSM diagnosis , or …. (shrink)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close (...) to that of Autism Spectrum Disorder. This opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

Using methods from anthropology and cognitive psychology, this study investigated the relationship between clinicians’ folk taxonomies of mental disorder and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Expert and novice psychologists were given sixty-seven DSM-IV diagnoses, asked to discard unfamiliar diagnoses, put the remaining diagnoses into groups that had “similar treatments” using hierarchical (making more inclusive and less inclusive groups) and dimensional (placing groups in a two-dimensional space) methodologies, and give names to (...) the groups in their taxonomies. Clinicians were familiar with a substantially smaller number of diagnoses than are in the DSM. Cultural consensus analysis and follow-up residual agreement analysis revealed similarities across clinicians’ folk taxonomies. Correlations between folk taxonomies and the DSM were moderate. Cluster analysis showed that clinicians preserved DSM higher order categories (e.g., mood disorders) but not the Axis I–Axis II distinction. This study suggests important differences between the way clinicians conceptualize mental disorders and the organization of the DSM-IV. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clarifying the Relationship Between Vice and Mental Disorder: Vice as Manifestation of a Psychological DysfunctionMichael B. First (bio)KeywordsDSM-IV, psychiatric diagnosis, impulse control disorders, sexually violent predator commitmentIndividuals generally present for psychiatric evaluation for one of two reasons: either because they themselves are suffering from a psychiatric symptom that causes distress (e.g., severe panic) or impairs their ability to function effectively (e.g., memory loss), or else they are (...) brought to clinical attention because their behavior or attitudes are considered by others to be problematic. There are a wide range of behaviors that fall into this second category. In some cases, the individual is pressured to seek treatment because of the negative impact that a behavior has on a relationship partner (e.g., sexual dysfunction, anger outbursts) or an employer (e.g., excessive alcohol use). Often, however, the external trigger for a clinical evaluation falls under Sadler’s definition of vice, that is, criminal (illegal) behaviors or attitudes that could be considered “wrongful” or “immoral” in the social arena because the behavior violates the law or an important social more.Given that one of the most important goals of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is to facilitate clinical practice (First et al. 2004) and in doing so provide a diagnostic code to cover any patient that might present himself or herself to a mental health professional, the DSM has evolved over its various editions to become a veritable laundry list of psychological and behavioral ills, some of which may constitute a violation of the rights of others or society. The DSM-III (and its successors) have adopted a descriptive approach wherein disorders are defined in terms of their presenting surface symptomatology, which was necessitated by the field’s lack of knowledge about the underlying etiology of mental disorders. Given this reliance on presenting symptoms, it is therefore inevitable that some disorders are defined in terms of behaviors that can be considered vices. For example, impaired impulse [End Page 35] control often leads to acting out behavior that, at its mildest is inappropriate, and at its most severe is destructive to self and others. Many of the disorders cited by Sadler as being vice-laden fall into this category, namely, pyromania (failure to resist impulses to set fires), kleptomania (failure to resist impulses to steal), intermittent explosive disorder (failure to resist aggressive impulses), certain forms of substance abuse (i.e., those involving possession and use of illegal substances) and paraphilias (i.e., those involving nonconsenting victims).It is important to clarify from the outset that the criteria for determining whether a behavior is a “vice” (i.e., whether it is illegal or immoral) is not equivalent to the criteria for determining whether a behavior is indicative of a mental disorder. According to the DSM-IV-TR definition, a mental disorder is conceptualized as a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychiatric Association [APA] 2000, xxxi). The definition warns against considering “deviant behavior[s] (e.g., political, religious, or sexual)” and “conflicts that are primarily between the individual and society” to be evidence of mental disorder except in those cases in which the “deviance or conflict is a symptom of a dysfunction in the individual.” Thus, when considering whether a particular “vice” behavior is a component of a mental disorder, it is crucial to determine whether the behavior is a manifestation of an underlying psychological dysfunction, such as a dysfunction in impulse control. If so, it may potentially be appropriate for that individual to be treated as “medically ill” in addition to, or instead of, being treated simply as a criminal.Let us examine some illustrative examples of cases that demonstrate the relationship between vice and mental disorders and the different ways in which the legal and mental health systems might deal with such cases. Consider the case of an individual who breaks... (shrink)

In this chapter, I provide an overview of phenomenological approaches to psychiatric classification. My aim is to encourage and facilitate philosophical debate over the best ways to classify psychiatric disorders. First, I articulate phenomenological critiques of the dominant approach to classification and diagnosis—i.e., the operational approach employed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Second, I describe the type or typification approach to psychiatric classification, (...) which I distinguish into three different versions: ideal types, essential types, and prototypes. I argue that despite their occasional conflation in the contemporary literature, there are important distinctions among these approaches. Third, I outline a new phenomenological-dimensional approach. I show how this approach, which starts from basic dimensions of human existence, allows us to investigate the full range of psychopathological conditions without accepting the validity of current diagnostic categories. (shrink)

This paper provides a historical analysis of a shift in the way animal models of mental disorders were conceptualized: the shift from the mid-twentieth-century view, adopted by some, that animal models model syndromes classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), to the later widespread view that animal models model component parts of psychiatric syndromes. I argue that in the middle of the twentieth century the attempt to (...) maximize the face validity of animal models sometimes led to the pursuit of the ideal of an animal model that represented a behaviorally defined psychiatric syndrome as described in manuals such as the DSM. I show how developments within psychiatric genetics and related criticism of the DSM in the 1990s and 2000s led to the rejection of this ideal and how researchers in the first decade of the twenty-first century came to believe that animal models of mental disorders should model component parts of mental disorders, adopting a so-called endophenotype approach. (shrink)

We may be at the brink of a Kuhnian paradigm shift when it comes to the categorical classification system of mental disorders. Reviewing more than 30 years of critical literature on the categorical classification of personality disorders, Kueger, Hopwood, Wright, and Markon conclude that the Diagnostic and Statistical Manual of Mental Disorders is "fundamentally broken". Just before, the director of the National Institute of Mental Health declared that the institute will no (...) longer support research that is based on DSM categories.The critique on the categorical system of mental disorders consists of several arguments that are briefly mentioned as they have been... (shrink)

There are different ways of responding to the absence of a shared physical causal core among the range of mental disorders currently recognized by the International Statistical Classification of Diseases and Related Health Problems and the Diagnostic and Statistical Manual of Mental Disorders. Obviously enough, some of the listed disorders are not physically explicable in principle, while others are merely likely to be biological in origin. Only a minority of disorders (...) can be explained as the outcomes of impaired biological function, and in some of those cases biological explanations capture their phenomena little more than partially. Psychiatry nevertheless is perceived as and understands itself... (shrink)

_Choice Recommended Read_ _What Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today_ covers the diagnoses that the _Diagnostic and Statistical Manual of Mental Disorders_ failed to include, along with diagnoses that should not have been included, but were. Psychiatry as a field is over two centuries old and over that time has gathered great wisdom about mental illnesses. Today, much of that knowledge has been ignored and we have diagnoses such as "schizophrenia" (...) and "bipolar disorder" that do not correspond to the diseases found in nature; we have also left out disease labels that on a historical basis may be real. Edward Shorter proposes a history-driven alternative to the DSM. (shrink)

In the United States, the National Institute of Mental Health is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders. A key mechanism for this is the “Research Domain Criteria” initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty (...) is constituted through discourse. In this paper, I explore and analyze these actors’ accounts of what is new, important, or desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary psychiatry and to contribute to science and technology studies debates about “the new” in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty. (shrink)

The failure of psychiatry to validate its diagnostic constructs is often attributed to the prioritizing of reliability over validity in the structure and content of the Diagnostic and Statistical Manual of Mental Disorders. Here I argue that in fact what has retarded biomedical approaches to psychopathology is unwarranted optimism about diagnostic discrimination: the assumption that our diagnostic tests group patients together in ways that allow for relevant facts about mental disorder to (...) be discovered. I consider the Research Domain Criteria framework as a new paradigm for classifying objects of psychiatric research that solves some of the challenges brought on by this assumption. (shrink)

A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions “an important loss of freedom” as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how “an important loss of freedom” should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss (...) of) freedom, in this article, I will explore the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future research. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) uses the conceptualization of psychopathology to make psychiatric diagnoses operational. The use of explicit operational criteria appears to be based on an implicit neo-positivist epistemology. Operationalism involves an excessive focus on quantitative descriptions of behavior manifestations, contesting that psychopathology is understood as a deviation from the normal or the average in a given population. Consequently, the normal and the psychopathological become homogeneous. Our analysis investigates (...) if this neo-positivist epistemology narrows psychopathology conceptualization and endanger integration with the hybrid biopsychosocial model of psychiatry. Based on Georges Canguilhem’s theorization of a qualitative approach to the individual organism who is in a state of morbidity, we show that the (psychiatric) pathology also contains differences in quality. Moreover, that humans are norm-producing organisms that actively respond to changes in their internal and external environment. In this regard, the operationalization of mental disorders could include the normativity in humans, i.e., the ability to produce norms. We argue this will mitigate the one-sided psychopathology conceptualization and strengthen the relationship between psychiatric nosology and psychiatry’s hybrid biopsychosocial model. (shrink)

Prior research supports the learnability of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alternative Model of Personality Disorders. However, researchers have yet to compare novice ratings on the AMPD’s Level of Personality Functioning Scale and the 25 pathological personality traits with expert ratings. Furthermore, the AMPD has yet to be examined with the idiographic Shedler-Westen Assessment Procedure. We compared the aggregated AMPD clinical profile of a group of psychology doctoral students who (...) learned the AMPD to high levels of reliability to that of an expert rater using the crucible of the classical case of “Madeline G.” Examination of AMPD and SWAP ratings of “Madeline G.” revealed excellent overall concordance but suggests that novice raters tend to perceive lower levels of personality impairment. (shrink)

Although the definition of a mental disorder has remained essentially the same from Diagnostic and Statistical Manual of Mental Disorder, Third Edition, Revised (DSM-III-R) through DSM-IV to DSM-IV-TR, the account of the paraphilias has changed continually. Although the definition in all the DSMs explicitly rules out deviant sexual behavior as sufficient for labeling someone as having a mental disorder, deviant sexual behavior counts as sufficient for all the paraphilias in DSM-III-R. In DSM-IV, the account (...) of all the paraphilias is made consistent with the definition. In DSM-IV-TR, mere deviant sexual behavior is not sufficient for being classified as having a paraphilia, but immoral deviant sexual behavior is. Thus, in DSM-IV-TR, only those paraphilias that involve immoral deviant sexual behavior are inconsistent with the definition, but deviant sexual behavior by itself does not count as a mental disorder. (shrink)

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s (...) descriptive diagnostic categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders classifies “anorexia nervosa” as a mental disorder, yet individuals with anorexia often characterize it as an identity. The author describes the identity of being an anorectic and compares it with what it takes to have anorexia in the diagnostic sense. This furthers the existing scholarship on anorexia and identity, most notably by revealing a disconnect between being an anorectic and having anorexia: Some individuals inhabit the (...) identity of being an anorectic but do not have anorexia because they do not have a significantly low body weight. The author explores whether expanding the diagnostic criteria for anorexia would be beneficial for anorectics by examining the implications of classifying the identitive phenomenon of being an anorectic in terms of a medical concept of mental disorder. In the short term, the answer depends on whether being an anorectic calls for interventions that require a diagnosis. Either way, it would be beneficial to develop nonmedical frameworks for understanding anorexia that facilitate interventions that do not require a diagnosis. Understanding being an anorectic as an identity lays the scaffolding for a nonmedical way of conceptualizing anorexia that illuminates innovative approaches to assisting anorectics. (shrink)

Machine learning (ML) has emerged as a promising tool in psychiatry, revolutionising diagnostic processes and patient outcomes. In this paper, I argue that while ML studies show promising initial results, their application in mimicking clinician-based judgements presents inherent limitations (Shatte et al. in Psychol Med 49:1426–1448. https://doi.org/10.1017/S0033291719000151, 2019). Most models still rely on DSM (the Diagnostic and Statistical Manual of Mental Disorders) categories, known for their heterogeneity and low predictive value. DSM's descriptive nature limits (...) the validity of psychiatric diagnoses, which leads to overdiagnosis, comorbidity, and low remission rates. The application in psychiatry highlights the limitations of supervised ML techniques. Supervised ML models inherit the validity issues of their training data set. When the model's outcome is a DSM classification, this can never be more valid or predictive than the clinician’s judgement. Therefore, I argue that these models have little added value to the patient. Moreover, the lack of known underlying causal pathways in psychiatric disorders prevents validating ML models based on such classifications. As such, I argue that high accuracy in these models is misleading when it is understood as validating the classification. In conclusion, these models will not will not offer any real benefit to patient outcomes. I propose a shift in focus, advocating for ML models to prioritise improving the predictability of prognosis, treatment selection, and prevention. Therefore, data selection and outcome variables should be geared towards this transdiagnostic goal. This way, ML can be leveraged to better support clinicians in personalised treatment strategies for mental health patients. (shrink)

This article does not directly consider the feelings and emotions that occur in mental illness. Rather, it concerns a higher level methodological question: To what extent is an analysis of feelings and felt emotions of importance for psychiatric classification? Some claim that producing a phenomenologically informed descriptive psychopathology is a prerequisite for serious taxonomic endeavor. Others think that classifications of mental disorders may ignore subjective experience. A middle view holds that classification should at least map the contours (...) of the phenomenology of mental illness. This article examines these options. I conclude that it is not true that phenomenology is a logical prerequisite for classification, nor even that classification should necessarily respect phenomenological boundaries, but that detailed phenomenological examination can sometimes inform classification. (shrink)

As a text in use by mental health practitioners, policy makers, and ordinary individuals, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes a variety of mental, psychological, and emotional experiences on a wide spectrum of disorders. Many common experiences are described there as symptoms, chiefly for the purposes of identifying, diagnosing, and treating disorders. “Disorientations” are not (yet) categorized as a stand-alone disorder in the DSM, but involve a cluster (...) of experiences that border on and overlap with experiences already categorized as symptoms of other disorders. Where experiences of disorientation appear in the DSM, they are, for the most part, still understood as.. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, emphasizes diagnosis and statistically significant commonalities in mental disorders. As stated in the Introduction, “[i]t must be admitted that no definition adequately specifies precise boundaries for the concept of ‘mental disorder’ ” (DSM-IV, 1994, xxi). Further, “[t]he clinician using DSM-IV should ... consider that individuals sharing a diagnosis are likely to be heterogeneous, even in regard to the defining features of the diagnosis, (...) and that boundary cases will be difficult to diagnose in any but a probabilistic fashion” (DSM-IV, 1994, xxii). This article proposes that it may be helpful for clinicians to study narratives of illness which emphasize this heterogeneity over statistically significant symptoms.This paper examines the recorded experiences of unusually articulate sufferers of the disorder classified as Major Depression. Although sharing a diagnosis, Hemingway, Fitzgerald, and Styron demonstrated different understandings of their illness and its symptoms and experienced different resolutions, which may have had something to do with the differing meanings they made of it.I have proposed a word, autopathography, to describe a type of literature in which the author's illness is the primary lens through which the narrative is filtered. This word is an augmentation of an existing word, pathography, which The Oxford English Dictionary, Second Edition, defines as “a) [t]he, or a, description of a disease,” and “b) [t]he, or a, study of the life and character of an individual or community as influenced by a disease.” The second definition is the one that I find relevant and which I feel may be helpful to clinicians in broadening their understanding of the patient's experience. (shrink)

Murphy (2006) criticizes psychiatric nosology from the perspective of the philosophy of science, arguing that the model of pathology as encapsulated in the Diagnostic and Statistical Manual of Mental Disorders reflects a folk conception of the mental, and of malfunctioning, that is inadequately integrated with cognitive and behavioral neuroscience. The present paper supports this view through a case study of research on pathological gambling. It argues that recent modeling based on fMRI studies and behavioral (...) genetics suggests a stipulative, non-seamless reduction of pathological gambling to a specific disorder of the mesolimbic dopamine system. This argument is agnostic as between prior philosophical commitments to realism or empiricism. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association [APA], 2013) defines melancholia as “A mental state characterized by very severe depressi...

Zachar's commentary can be read as a sophisticated theoretical extension of the target article, and I am very pleased to see support for a relationalist turn in understanding mental disorders. Indeed, underlying causal properties are only an ingredient of essentialism and a more elaborate discussion of this issue brings us readily to the discourse on kinds and ontology. Zachar is an advocate for thinking of psychiatric constructs as practical kinds. This logically leads him to think that the problem (...) with categorical classification systems like the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases are practical problems (lack of... (shrink)

The last two decades have seen a dramatic increase in scientific publications on Tourette syndrome, but the etiology of this common neurodevelopmental condition is still unknown. Many questions remain—about the unitary nature of the syndrome, and the criteria used to define it in such internationally accepted manuals as the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Disorders. Meanwhile, individuals and families affected by TS remain underserviced, as pharmacological and behavioral (...) therapies provide relief for some but not all who need support. We urgently need new... (shrink)

The Malleus Maleficarum was a detailed manual for Dominican witch-hunters. It codified specific criteria for identifying witches and guidelines for their application. It elaborated a system of symptoms that indicated illness caused by witchcraft . These symptoms were seen as the visible projections of a vast and complex organization of behavior. Since the existence of witches was presupposed by those who used the manual, its criteria were confirmed repeatedly during the Inquisition. Once the Malleus was published, its (...) class='Hi'>diagnostic system acquired a momentum of its own and generated its own evidence . Its authors saw physicians as experts at distinguishing physical illnesses from those caused by witchcraft. The authors began the manual by asserting that belief in the existence of witches is an essential part of the Catholic faith. Priests and inquisitors were not to doubt the existence of witches . Like the Malleus Maleficarum, the Diagnostic and Statistical Manual is a detailed text which codifies specific criteria for identifying people who are seen as abnormal. It codifies guidelines for applying these criteria and elaborates a system of symptoms that indicates illnesses known as mental disorders. These symptoms are seen as the visible projections of a vast and complex organization of behavior. Since the existence of these disorders is presupposed by many of those who use the manual, its criteria are confirmed repeatedly in the diagnostic process. Once DSM was published , its diagnostic system acquired a momentum of its own and has generated its own evidence. Its authors regard psychiatrists as experts at applying the manualís criteria. They are also seen as experts at distinguishing mental disorders from other illnesses. Belief in the existence of mental disorders is an essential part of the psychiatric faith. (shrink)

Guidelines for revisions to Diagnostic and Statistical Manual of Mental Disorders, 5th edition asked those proposing certain types of revision to consider potential harms to patients. Specifically, those proposing new diagnoses were to consider whether ‘the harm that arises from the adoption of the proposed diagnosis exceed[s] the benefit that would accrue to affected individuals’, and potential for harm was cited as a possible reason for keeping a diagnosis in the appendix rather than promoting it (...) to the main classification. The ‘do no harm’ criterion was referred to in... (shrink)

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is universally acknowledged as the prominent reference textbook for the diagnosis and assessment of psychiatric diseases. However, since the publication of its first version in 1952, controversies have been raised concerning its reliability and validity and the need for other novel clinical tools has emerged. Currently the DSM is in its fourth edition and a new fifth edition is expected for release in 2013, in an intense (...) intellectual debate and in a call for new proposals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethics of Surgical Interventions for Body Integrity Identity Disorder and Gender DysphoriaNicanor Pier Giorgio Austriaco, O.P.IntroductionOn May 20, 2009, Fox News featured a report that described the life of a man named "John" who had spent his life struggling with Body Integrity Identity Disorder (BIID).1 In a phone interview, John admitted that he remembers wanting to amputate his leg when he was between seven and eleven years of (...) age, by sticking his leg under the rear wheel of a bus. He never went through with it but continued to experience an intense desire to amputate his healthy limb for the following fifty-plus years. Described for the first time in 1977 as apotemnophilia, BIID was originally thought to be a psychological disorder characterized by sexual arousal associated with the desire to be an amputee. However, it was renamed when Dr. Michael First, a professor of clinical psychiatry at Columbia University, proposed that the primary motivation behind the condition was an issue of identity rather than of sexual desire.2 This proposal is controversial.3 Despite much [End Page 1003] debate, BIID was not included in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was published on May 18, 2013.In this essay, we will consider the ethics of surgical interventions for BIID and Gender Dysphoria (GD).4 We begin with a discussion of the principle of totality that distinguishes ethical from unethical modifications of the body. We will refer specifically to the latter category of surgical interventions as "mutilations," though the Catholic moral tradition's use of the term is itself ambiguous.5 This is followed by an extensive moral discussion of (1) amputations of healthy limbs for patients struggling with BIID and (2) sex reassignment surgeries for those who identify themselves as transgender persons. I will propose that an ethical argument can be made to justify the former but not the latter.The Principle of TotalityBecause of the goodness of the human body, its integrity is a good that has to be protected and preserved. The ethical principle that is used to judge the morality of bodily interventions that impinge upon this bodily integrity is the principle of totality.6 It was articulated by St. Thomas Aquinas in his Summa theologiae as follows:Since a member is part of the whole human body, it is for the sake of the whole, as the imperfect for the perfect. Hence a member of the human body is to be disposed of according as it is expedient for the body.... If, however, the member be decayed and therefore a source of corruption to the whole body, then it is lawful with the consent [End Page 1004] of the owner of the member, to cut away the member for the welfare of the whole body.7Over the centuries, Catholic moral theologians appealed to the principle of totality to justify three different scenarios that involved the sacrifice of a bodily organ for the sake of the whole human organism. The first case involves a diseased organ that has to be removed to save the life of the soldier wounded on the battlefield—say a gangrenous, decaying limb as in the example of Aquinas. The second case involves the healthy foot of a man who is trapped on a railroad track that has to be amputated to save his life from a collision with a train, and the third case involves the healthy limb of an individual that has to be amputated in response to a tyrant who orders him to cut off his own hand or lose his head to the executioners instead. In these cases, the sacrifice of the part would be morally permitted as a necessary means of preserving the life of the individual. As Fr. Gerald Kelly, S.J., points out, this final case is particularly significant because it involves a healthy limb whose very presence—and not its diseased or trapped condition—becomes a source of vital harm for the organism.8How does one justify the principle of totality? In 1944, Pope Pius XII explained it this way: "Man's power over his... (shrink)

The Diagnostic and Statistical Manual of Mental Disorders is the guidebook for psychiatric practice in medicine. In the fifth edition, published in 2013, the American Psychiatric Association significantly revised the section on gender identity disorder, which it renamed gender dysphoria. In previous editions, the conviction that one’s sex did not match one’s gender was treated as a mental disorder in need of psychiatric treatment. In DSM-5, the remedy for that same conviction was changed to (...) hormonal and surgical procedures to give the patient the appearance of the opposite sex. A complete reversal of this sort is surprising, as it implies that all previous guidance on this question was in error. The change is even more perplexing given that little evidence shows that hormonal or surgical interventions actually improve the psychological health of the sufferer. (shrink)

The introduction of the Diagnostic and statistical manual of mental disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview . Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion (...) of “construct validity” and “conceptual validity” and a failure to distinguish between “disorder” and “non disordered conditions for which we help people.” The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to “degrees of severity” of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The history of mental illnesses is as old as human history. Mental disorders are affected by changing social and cultural factors during the historical process, and have been conceptually restructured and their definitions and classifications have been changed. The evolution of obssessive-compulsive disorders with roots as old as human history into modern concepts took place in the 19th century. The first scientific views on the spiritual origin of OCD belong to S. Freud. Freud observed that (...) class='Hi'>mental causes in OCD are different from other mental disorders, and he examined obsession as a separate and specific disorder. Over time, it has been understood that OCD is a very common disorder. The American Psychiatric Association (APA) has classified OCD under an independent title in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by removing it from the category of anxiety disorders. OCD is a mental disorder caused by mental actions such as obsessive thoughts (obsessions) and / or repetitive and compulsive behaviors (compulsion). The patient is often aware that such thoughts and behaviors are irrational and absurd. For this reason, he tries to get away obsessive thoughts that he finds contrary to his beliefs, opinions, moral values and logic from his mind. However, as he tries, obsessive thoughts become more and more frequent and create a great anxiety in the person. This time, the patient resorts to compulsions to alleviate the anxiety he feels or to get rid of it completely. As his compulsions repeat, his anxiety increases and he goes into a vicious circle. There are many symptom subgroups of OCD that seriously worsen the quality of life of the individual. One of these, and even the most overwhelming, is religious obsessions. It has been thought that there has been a relationship between religion and OCD for a long time in the psychology literature, and some remarkable studies have been conducted to clarify this relationship. Although there are many research findings showing that religion is an indispensable element in the protection of the mental health integrity of the individual, some forms of religious understanding and some experiences gained as a result of religious experiences may affect the concerns about OCD. This stage of religiosity is closely related to some sub-symptom groups of OCD. The explanations of the founder of the psychoanalytic method, Freud psychoanalytic method, and his followers made a great contribution to the understanding of OCD. However, since the psychoanalytic method exhibits a theoretically reductionist approach to religion, it is possible that the individual's devotion to religion is initially evaluated as a pathology or at least an important obstacle to insight. Today, cognitive behavioral psychotherapies are considered the most effective psychological treatment method for OCD, but their success rates in the treatment of religious OCD are low. Since religious OCD concerns often involve spiritual issues rather than concrete repeatable situations, behavioral methods can be quite difficult to apply in the treatment of religious OCD. Therefore, traditional psychotherapy approaches, even if they are not openly against religions, are insufficient to relieve the suffering in the lives of individuals with religious obsessions, as they generally neglect the religious dimension. Due to the vacuum that arises from restricting spiritual treatments to secular approaches, religious patients are threatened by the illegal practices of people who abuse religious feelings. Clinically, religious obsessions are more worrying and overwhelming. Therefore, their treatment is more difficult than others. Selective approaches that use different scientific disciplines together in the treatment of OCD and can stretch around religious beliefs and values can create more effective treatment models. Thus, the success rate in the treatment of religious OCD can be carried to higher levels thanks to the appropriate cooperation of the disciplines of medicine, psychology and theology. There is a rich religious cultural heritage that can support this collaboration in terms of theological disciplines. As an example, Abū Zayd al-Balkhī (d. 322/934), in his Maṣāliḥ al-abdān wa-l-anfus, probably made a clear distinction between neuroses and psychosis and classified neurotic disorders for the first time about ten centuries before Freud. In this study, the importance of approaching to religious obsessions as both a psychological disorder and a theological problem is emphasized. For this reason, cooperation of psychiatric and psychological approaches with spiritual counseling and guidance is recommended in the treatment of religious OCD. The difficulty in distinguishing whether the symptoms seen in a religious person are normal, natural religious thoughts and behaviors of religious life or abnormal appearances in the religious guise necessitates this interdisciplinary cooperation. (shrink)