The rise of normality in the Diagnostic and Statistical Manual of Mental Disorders: Causes and implications for diagnosis, practice, and validity.

Abstract

The use of "normal" and related terms has increased across successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), from DSM-I to DSM-5. Despite its widespread use, "normal" remains an ambiguous and context-dependent term, reflecting statistical frequency and sociocultural expectations. "Normal" is also commonly understood as indicative of health. This Viewpoint examines the increasing use of normality-related concepts in recent editions of the DSM and emphasizes how the term "normal" has been used to distinguish between health and illness-often without a clear definition. Dimensional approaches to mental disorders-because they often rely on normative data and expectations to define the boundaries of these dimensions-do not resolve this ambiguity; instead, they amplify the need to clarify the meaning of normality. Moreover, emerging technologies such as digital phenotyping and big data analysis may exacerbate these issues by equating statistical averages with indicators of mental health. We conclude that psychiatry must either critically reevaluate its reliance on the concept of normality within diagnostic systems or, alternatively, offer a clear and consistent definition of what "normal" means in relation to health and what it is intended to signify. (PsycInfo Database Record (c) 2025 APA, all rights reserved).