Petretto Donatella Rita, Mura Alessandro, Carrogu Gian Pietro, Gaviano Luca, Atzori Riccardo, Vacca Mattia
Department of Education, Philosophy, Psychology, State University of Cagliari, Cagliari, Italy.
Front Psychol. 2025 Jun 2;16:1545341. doi: 10.3389/fpsyg.2025.1545341. eCollection 2025.
Since ancient times, and later in the 17th and 18th centuries, scholars have sought to classify mental disorders. However, it wasn't until the late 1970s, with the work of Spitzer and Endicott and the publication of the DSM-III, that a formal definition of mental disorder was established. Once this milestone was reached, a long and complex debate on the definition of mental disorder started. Here we aim to review such a debate, taking into consideration the papers that have proposed and/or investigated and discussed the various definitions of mental disorder over the past 50 years.
We conducted the literature review via Scopus, PubMed, and Web of Science databases. The following inclusion criteria were established: papers on the definition of mental disorder, written in English. All study designs were eligible, including those that utilized qualitative and quantitative methods, as well as methodology or guideline reports.
The sorted papers ( = 64) showed a complex, long and still ongoing debate on the definition of mental disorder. Only few authors directly proposed their own definitions, while others analyzed, discussed, criticized and/or proposed integrations to previous or current definitions. The authors of the selected papers conducted their work alongside the development of various editions of the main international diagnostic manuals (primarily the DSM). Many of them directly engaged with past and present definitions of mental disorder provided in the mentioned manuals or referenced different editions of both DSM and ICD.
We concluded that despite the complex and still ongoing debate on the topic, and the precious contributions from all the authors involved, a unique and agreed-upon definition of the concept of mental disorder is still far from being identified. Furthermore, even if the definitions proposed by the international diagnostic manuals (especially by the DSM) constitutes an undeniable landmark, such definitions resulted to be more the outcome of various discussions, than the fruit of a shared consensus. The construct of mental disorder and its shared definition remain a critical theme in psychopathology.
自古以来，以及在17和18世纪，学者们就试图对精神障碍进行分类。然而，直到20世纪70年代末，随着斯皮策（Spitzer）和恩迪科特（Endicott）的工作以及《精神疾病诊断与统计手册》第三版（DSM-III）的出版，精神障碍的正式定义才得以确立。一旦达到这一里程碑，关于精神障碍定义的漫长而复杂的辩论就开始了。在此，我们旨在回顾这场辩论，同时考虑过去50年中提出和/或研究及讨论精神障碍各种定义的论文。
我们通过Scopus、PubMed和科学网数据库进行文献综述。确立了以下纳入标准：以英文撰写的关于精神障碍定义的论文。所有研究设计均符合要求，包括那些采用定性和定量方法的研究，以及方法学或指南报告。
筛选出的论文（n = 64）显示，关于精神障碍的定义存在复杂、漫长且仍在进行的辩论。只有少数作者直接提出了自己的定义，而其他作者则对先前或当前的定义进行了分析、讨论、批评和/或提出整合建议。所选论文的作者在主要国际诊断手册（主要是DSM）各版的编写过程中开展工作。他们中的许多人直接探讨了上述手册中提供的精神障碍的过去和当前定义，或参考了DSM和ICD的不同版本。
我们得出的结论是，尽管关于该主题的辩论复杂且仍在进行，并且所有参与作者都做出了宝贵贡献，但精神障碍概念的独特且一致认可的定义仍远未确定。此外，即使国际诊断手册（尤其是DSM）提出的定义构成了不可否认的里程碑，但这些定义更多是各种讨论的结果，而非共同共识的产物。精神障碍的概念及其共同定义仍然是精神病理学中的一个关键主题。
