Am J Psychiatry 1992; 149:240-244
Copyright © 1992 by American Psychiatric Association
Now is the time to retire the term "organic mental disorders"
RL Spitzer, MB First, JB Williams, K Kendler, HA Pincus and G Tucker
Department of Psychiatry, Columbia University, New York, NY.
The organic/nonorganic distinction in contemporary classifications of
mental disorders such as DSM-III and DSM-III-R has important prognostic and
treatment implications, because it directs the clinician to pay special
attention to the possibility of an underlying "physical" disorder as the
cause of the mental disturbance. However, the term "organic" raises serious
and intractable problems, since the connotative meaning of the term always
returns to its historical roots, which imply an outmoded
functional/structural, psychological/biological, and mind/body dualism. The
authors present a proposal being considered for DSM-IV that would eliminate
the term "organic" and reorganize the classification of organic mental
disorders. Disorders previously referred to as "organic mental disorders"
would be renamed as either "secondary disorders" (if they are due to
"physical" disorders) or "substance-induced disorders." The entire
classification of mental disorders would be reorganized to distribute the
secondary and substance-induced disorders into the major groups with which
they share phenomenology. The traditional organic mental
disorders--delirium, dementia, and amnestic disorder--would be grouped
together under the rubric of "cognitive impairment disorders." While
acknowledging problems with the suggested new terminology and
reorganization of the classification, the authors argue that the potential
benefits of the proposal for clarity and for facilitating differential
diagnosis justify putting to rest the familiar but now anachronistic term
"organic mental disorders."
