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HDA holds that both harm and dysfunction must be present for a condition to be a mental disorder. Dysfunction provides the objective basis for diagnosis; harm adds cultural sensitivity. As a result, not all dysfunctions are mental disorders, and not every harmful condition is a mental disorder.
An example Wakefield uses to prove this is dyslexia.<ref>{{Cite journal |last=Wakefield |first=Jerome |date=2021-02-16 |title=Can the Harmful Dysfunction Analysis Distinguish Problematic Normal Variation from Disorder? Reply to Andreas De Block and Jonathan Sholl |url=https://direct.mit.edu/books/oa-edited-volume/5015/chapter-standard/2812074/Can-the-Harmful-Dysfunction-Analysis-Distinguish |journal=MIT Press |language=en |doi=10.7551/mitpress/9949.003.0032}}</ref> Essentially, dyslexia is a failure of the brain's language-processing system and therefore counts as a dysfunction. However, whether it is considered a mental disorder depends on the cultural context. In a literate society, where reading is indispensable to daily life, dyslexia leads to clear disadvantages, making it a disorder. In a pre-literate society where reading is not a necessary skill, it would cause no harm and not be viewed as a disorder. Wakefield describes such cases as “harmless
== Criticisms ==
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Critics of the dysfunction requirement argue that it is often difficult, if not impossible, to identify the evolved function of complex mental mechanisms.<ref>{{Cite journal |last=McNally |first=Richard J |date=2001-03-01 |title=On Wakefield's harmful dysfunction analysis of mental disorder |url=https://www.sciencedirect.com/science/article/abs/pii/S0005796700000681?via=ihub |journal=Behaviour Research and Therapy |volume=39 |issue=3 |pages=309–314 |doi=10.1016/S0005-7967(00)00068-1 |issn=0005-7967}}</ref><ref>{{Cite journal |last=Aftab |first=Awais |last2=and Rashed |first2=Mohammed Abouelleil |date=2021-07-04 |title=Mental disorder and social deviance |url=https://www.tandfonline.com/doi/full/10.1080/09540261.2020.1815666 |journal=International Review of Psychiatry |volume=33 |issue=5 |pages=478–485 |doi=10.1080/09540261.2020.1815666 |issn=0954-0261 |pmid=33016793}}</ref> Many mental functions may have arisen as by-products of other adaptations or evolved to serve multiple purposes, making it challenging to pinpoint a clearly ‘designed’ function.
Philosopher Maël Lemoine questioned whether the dysfunction component is genuinely value-free, suggesting it inherently involves interpretive assumptions, not just description.<ref>{{Cite journal |last=Lemoine |first=Maël |date=2021-02-16 |title=Is the Dysfunction Component of the “Harmful Dysfunction Analysis” Stipulative? |url=https://direct.mit.edu/books/oa-edited-volume/5015/chapter/2812058/Is-the-Dysfunction-Component-of-the-Harmful |journal=MIT Press |language=en |doi=10.7551/mitpress/9949.003.0016}}</ref> Further, Justin Garson points to developmental plasticity, the capacity to develop different traits in response to early environments, as a challenge to the dysfunction requirement of HDA. He argues that this adaptability can lead to "mismatches", where traits that were once beneficial in childhood become harmful later in life.
=== On Harm ===
The harm component has also attracted criticism, particularly regarding its reliance on social values. Rachel Cooper has argued that while the harm
Furthermore, Andreas De Block and Jonathan Sholl question whether harm should be determined through social values or individual experience. They argue that both approaches present problems. If harm depends on local social norms, the concept becomes vulnerable to culturally biased conclusions. For example, it could justify labelling homosexuality a disorder in heteronormative societies if it is also assumed to involve dysfunction. Alternatively, if harm is based on an individual's subjective experience, HDA would encourage diagnostic inconsistencies, as some individuals with severe disorders may not perceive themselves as harmed. In either case, they conclude that the harm requirement introduces enough subjectivity to undermine HDA's goal of offering a coherent definition of mental disorder. Additionally, they argue that Wakefield "smuggles" the harm component into his account of dysfunction, implicitly using harm to decide whether dysfunction is present. As a result, the two concepts do not seem truly independent as Wakefield suggests.<ref>{{Cite journal |last=De Block |first=Andreas |last2=Sholl |first2=Jonathan |date=2021-02-16 |title=Harmless Dysfunctions and the Problem of Normal Variation |url=https://direct.mit.edu/books/oa-edited-volume/5015/chapter/2812073/Harmless-Dysfunctions-and-the-Problem-of-Normal |journal=MIT Press |language=en |doi=10.7551/mitpress/9949.003.0031}}</ref>
=== Alternative Models ===
Notably, Christopher Boorse continues to defend his biostatistical theory of mental disorder. Boorse argues his model avoids the ambiguities associated with cultural judgements.<ref>{{Citation |last=Boorse |first=Christopher |title=A Rebuttal on Health |date=1997 |work=What Is Disease? |pages=1–134 |editor-last=Humber |editor-first=James M. |url=https://link.springer.com/chapter/10.1007/978-1-59259-451-1_1 |access-date=2025-04-17 |place=Totowa, NJ |publisher=Humana Press |language=en |doi=10.1007/978-1-59259-451-1_1 |isbn=978-1-59259-451-1 |editor2-last=Almeder |editor2-first=Robert F.}}</ref> He also contends that HDA conflicts with actual medical practice, particularly in its treatment of so-called ‘harmless dysfunctions’. He notes that many such conditions
== References ==
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