How to define today a medical disorder? Biological and psychosocial disadvantages as the paramount criteria

• Published in: Journal of evaluation in clinical practice 2022-12, Vol.28 (6), p.1195-1204
• Main Authors: Telles Correia, Diogo, Stoyanov, Drozdstoy, Rocha Neto, Helio G.
• Format: Article
• Language: English
• Subjects: classification; diagnostic classification; diagnostic criteria; Disease; epistemology; history of medicine; Humans; Medical diagnosis; Reproducibility of Results
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.13592

Background The 20th century has seen great developments in the concept of disease. Marked by the biopsychosocial paradigm, several strategies for disease definition were added to previous descriptive organic views, but a final concept is still out of reach. Method A critical review was carried out on thorough analysis of articles and textbooks to describe the main concepts and definitions of disease. Results The concept ‘disease’ is a pragmatic construct, not a natural kind. Three main ways to define disease were identified, and characterized: Biological (disease as a lesion, disadvantage/deviation from normal and dysfunction), Psychosocial (distress and disability, existential potentials, descriptive prototype, and prototype typification), and values‐based definition. Conclusion All the paradigms have advantages and flaws, but progressive use of all criteria in disease definition adds validity and reliability to diagnostic constructs. Such constructs must be, above all, useful for practice and research. Biological paradigm is relevant, but fails to cover all the complexity that involves human illness and the treatment process. An emphasis on distress, dysfunction, and carefully selected value‐laden characteristics might be the right direction for useful diagnostic construct conceptions.