Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder
- PMID: 33093836
- PMCID: PMC7523554
- DOI: 10.3389/fpsyt.2020.558655
Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder
Abstract
Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield's "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.
Keywords: antisocial personality disorder; definition of mental disorder; diagnostic criteria; dissocial personality disorder; harmful behavior; pedophilia; pedophilic disorder; psychopathy.
Copyright © 2020 Münch, Walter and Müller.
Similar articles
-
Psychopathy/antisocial personality disorder conundrum.Aust N Z J Psychiatry. 2006 Jun-Jul;40(6-7):519-28. doi: 10.1080/j.1440-1614.2006.01834.x. Aust N Z J Psychiatry. 2006. PMID: 16756576 Review.
-
Antisocial Personality Disorder (Nursing).2024 Feb 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 2024 Feb 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 33760489 Free Books & Documents.
-
Harm should not be a necessary criterion for mental disorder: some reflections on the DSM-5 definition of mental disorder.Theor Med Bioeth. 2019 Aug;40(4):321-337. doi: 10.1007/s11017-019-09499-4. Theor Med Bioeth. 2019. PMID: 31535312
-
[Evaluation of typical psychopathic traits with juvenile offenders].Encephale. 2004 Jul-Aug;30(4):369-75. doi: 10.1016/s0013-7006(04)95450-4. Encephale. 2004. PMID: 15597464 French.
-
[Diagnostic structured interviews in child and adolescent's psychiatry].Encephale. 2004 Mar-Apr;30(2):122-34. doi: 10.1016/s0013-7006(04)95422-x. Encephale. 2004. PMID: 15107714 Review. French.
Cited by
-
Pathways to antisocial behavior: a framework to improve diagnostics and tailor therapeutic interventions.Front Psychol. 2023 Feb 9;14:993090. doi: 10.3389/fpsyg.2023.993090. eCollection 2023. Front Psychol. 2023. PMID: 36844347 Free PMC article.
-
The evolution of personality disorders: A review of proposals.Front Psychiatry. 2023 Jan 30;14:1110420. doi: 10.3389/fpsyt.2023.1110420. eCollection 2023. Front Psychiatry. 2023. PMID: 36793943 Free PMC article. Review.
References
-
- Hucklenbroich P. “Die wissenschaftstheoretische Struktur der medizinischen Krankheitslehre”. In: Hucklenbroich P, Buyx A, editors. Wissenschaftstheoretische Aspekte des Krankheitsbegriffs. Münster: mentis; (2013). p. 13–83
-
- American Psychiatric Association Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association: Arlington, VA: (2013)
LinkOut - more resources
Full Text Sources