Post by Master Kim on Nov 7, 2014 17:06:10 GMT -5
in the Journal of the American Medical Association in 1962
On the Distinction Between Disease and Disorder
Ashley Montagu, Ph.D., Princeton, N.J.
The concepts and the terms "disease" and "disorder" have long been used synonymously and interchangeably both in medicine and in common parlance. It seems that it would constitute a contribution to greater clarity of thought and practice were these two concepts recognized for what they are, as referring to 2 quite different colligations of conditions.
To begin with the definition of these two orders of conditions:
Disease is an acquired morbid change in any tissue or tissue of an organism, or in an organism as a whole, of specific microorganismal causation with characteristic symptoms.
Disorder is a disturbance of structure or function or both due to a genetic or embryological failure in development or as the result of exogenous factors, such as certain chemical substances, injury, or disease. It may be inborn or acquired.
The difference between the concept of disease and that of disorder implied in these definitions lies in the fact that disease is conceived as being limited to malfunctioning of the organism initiated and maintained by an infectious process.
A disorder may or may not be initiated by an infectious process, but, however initiated, the malfunctioning is not maintained by an infectious process. A disorder may be the result of an infectious process, remaining long after the infection has ceased. A disorder may also be the result of a noninfectious process, such as an inborn error of metabolism due to some enzymatic deficiency, or to a chromosomal abnormality. In this class of conditions the disorder is maintained by a noninfectious derangement of chemical conditions. Diabetes mellitus is a disorder, not a disease, because it is neither initiated nor maintained by an infectious process but by a physiological failure of the pancreas.
What is the disorder in diabetes? Is it the failure of the pancreas to secrete a sufficient amount of insulin or is it the distressing syndrome of symptoms to which it gives rise? The answer, surely, is that it is each and both.
A prediabetic may show no symptoms whatever, but in most cases the proper tests will show that the disorder is present. Overt symptoms may not develop for several years. The pancreatic deficiency represents the physiological disorder, which may or may not have a genetic basis; the overt, visible, expression of the physiological disorder, resulting in the typical symptoms of diabetes, is the phenotypic disorder. Since the term phenotype is generally taken to mean the visible expression of the genotype, it may be preferable to speak simply of overt disorder, in order to distinguish it from the physiological or covert disorder.
As we enter upon the second half of the 20th century it will become necessary to distinguish sharply and clearly between malfunction and maldevelopment due to hereditary conditions, chromosomal abnormalities, infections, and environmental conditions. Each of these distinctions should be clearly recognized in describing any condition of the organism in which they are involved.
Down's syndrome (mongolism) is not a disease; it is a disorder or a syndrome, just as are Klinefelter's or Turner's syndromes. All malfunctioning and maldevelopment due to genetic factors and chromosomal abnormalities are disorders or syndromes, not diseases. The malfunctioning resulting from an infarct of the myocardium is a disorder, not a disease, even though the changes leading to the infarct may have had an infectious origin.
Active tuberculosis is a disease, but long after the disease has become inactive a disorder may remain.
Difference between Disorder and Disease? - allnurses.com/nursing-student-assistance/difference-between-disorder-333546.html
On the Distinction Between Disease and Disorder
Ashley Montagu, Ph.D., Princeton, N.J.
The concepts and the terms "disease" and "disorder" have long been used synonymously and interchangeably both in medicine and in common parlance. It seems that it would constitute a contribution to greater clarity of thought and practice were these two concepts recognized for what they are, as referring to 2 quite different colligations of conditions.
To begin with the definition of these two orders of conditions:
Disease is an acquired morbid change in any tissue or tissue of an organism, or in an organism as a whole, of specific microorganismal causation with characteristic symptoms.
Disorder is a disturbance of structure or function or both due to a genetic or embryological failure in development or as the result of exogenous factors, such as certain chemical substances, injury, or disease. It may be inborn or acquired.
The difference between the concept of disease and that of disorder implied in these definitions lies in the fact that disease is conceived as being limited to malfunctioning of the organism initiated and maintained by an infectious process.
A disorder may or may not be initiated by an infectious process, but, however initiated, the malfunctioning is not maintained by an infectious process. A disorder may be the result of an infectious process, remaining long after the infection has ceased. A disorder may also be the result of a noninfectious process, such as an inborn error of metabolism due to some enzymatic deficiency, or to a chromosomal abnormality. In this class of conditions the disorder is maintained by a noninfectious derangement of chemical conditions. Diabetes mellitus is a disorder, not a disease, because it is neither initiated nor maintained by an infectious process but by a physiological failure of the pancreas.
What is the disorder in diabetes? Is it the failure of the pancreas to secrete a sufficient amount of insulin or is it the distressing syndrome of symptoms to which it gives rise? The answer, surely, is that it is each and both.
A prediabetic may show no symptoms whatever, but in most cases the proper tests will show that the disorder is present. Overt symptoms may not develop for several years. The pancreatic deficiency represents the physiological disorder, which may or may not have a genetic basis; the overt, visible, expression of the physiological disorder, resulting in the typical symptoms of diabetes, is the phenotypic disorder. Since the term phenotype is generally taken to mean the visible expression of the genotype, it may be preferable to speak simply of overt disorder, in order to distinguish it from the physiological or covert disorder.
As we enter upon the second half of the 20th century it will become necessary to distinguish sharply and clearly between malfunction and maldevelopment due to hereditary conditions, chromosomal abnormalities, infections, and environmental conditions. Each of these distinctions should be clearly recognized in describing any condition of the organism in which they are involved.
Down's syndrome (mongolism) is not a disease; it is a disorder or a syndrome, just as are Klinefelter's or Turner's syndromes. All malfunctioning and maldevelopment due to genetic factors and chromosomal abnormalities are disorders or syndromes, not diseases. The malfunctioning resulting from an infarct of the myocardium is a disorder, not a disease, even though the changes leading to the infarct may have had an infectious origin.
Active tuberculosis is a disease, but long after the disease has become inactive a disorder may remain.
Difference between Disorder and Disease? - allnurses.com/nursing-student-assistance/difference-between-disorder-333546.html