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DSM-5 is published by the American Psychiatric Association and reflects a medical approach to identifying mental health problems. According to the DSM-5 definition, mental disorders reside within the individual, just like medical illnesses. For example, if someone is diagnosed with smallpox, we know that the illness is caused by a virus that has infected the person’s body. The virus causes symptoms (e.g., fatigue, fever, rash) that lead to severe impairment and an increased risk of death. Similarly, practitioners who adopt the medical model for mental disorders assume that if a child exhibits behavioral, cognitive, or emotional symptoms, these problems are caused by some underlying dysfunction within the child that causes distress or impairment (Stein et al., 2010c).

There are at least three limitations with the DSM-5 medical conceptualization of mental disorders, especially when it is applied to children and adolescents. First, we often do not know the underlying cause for children’s psychological problems. When physicians first described smallpox in the 15th century, they diagnosed the illness based on its symptoms: small blisters (i.e., pox) on the skin. It was not until many years later that researchers discovered that smallpox is caused by a viral infection, not the blisters themselves. Similarly, when a mental health professional diagnoses a child with ADHD, they are describing the child’s symptoms (i.e., hyperactivity and/or inattention), not the underlying cause of the disorder. Although researchers have identified several risk factors for ADHD, a single underlying cause for the disorder remains elusive (Pliszka, 2016).

Second, many childhood disorders are relational in nature—that is, they occur between people rather than within an individual. Consequently, childhood disorders are best understood in an interpersonal context. For example, young children with oppositional and defiant behavior argue with adults, refuse to comply with requests, and throw tantrums when they do not get their way. Interestingly, their defiant behavior is often directed at some adults (e.g., parents) but not others (e.g., teachers). Therefore, the disorder seems to be dependent on the relationship between the child and specific people; it does not merely reside within the child. Relationships may be especially important to mental disorders in children and adolescents, who are highly dependent on other people for their well-being (Heyman & Slep, 2020).

Third, children’s behavior can only be understood in terms of their social–cultural surroundings. Behaviors that people would consider “dysfunctional” in one context might be adaptive in a different setting. For example, consider a girl named Nia who lives with her parents on a military base in California. Upon hearing that her mother will soon be deployed to a combat area, Nia becomes excessively clingy with both parents, has problems eating and sleeping, and refuses to go to school. According to the harmful dysfunction criteria, Nia would likely be diagnosed with an anxiety disorder because (1) she has problems regulating her emotions and (2) these problems limit her social and academic functioning. However, her anxiety might be justified given her social context—that is, the imminent deployment of her mother. Behavior is best understood in the context of children’s social–cultural surroundings, never in isolation (Achenbach, 2019).

Review

 According to DSM-5, a mental disorder reflects a biological, developmental, or psychological dysfunction that causes disability or distress in the individual. This definition borrows from Wakefield’s notion of a harmful dysfunction.

 DSM-5 adopts a medical approach to mental disorders.

 The medical approach is limited when applied to children and adolescents because (1) we cannot always identify the underlying cause of children’s disorders, (2) many childhood disorders are best understood in an interpersonal context rather than existing only within the child, and (3) children’s behavior is best understood in terms of their social–cultural surroundings.