What makes a problem clinical?

Written By: Marie Chesaniuk, PhD

“What makes a problem clinical?” is actually several questions all rolled into one. From a client’s perspective, the question is, “What makes a problem professional help-worthy?” or, “How do I use my subjective experience of mental wellbeing to tell me if I’m ‘better’ now?” From diagnostic stance, the question is, “What criteria does the DSM-5-TR require to make a diagnosis?” Let’s answer all the questions within the question.

“What makes a problem professional help-worthy?”

Most important here are suffering and impairment (which have quite a bit of overlap with DSM ideas of clinical significance.) Does the problem cause the person suffering? One could argue that this alone is sufficient reason to seek professional help. Why wait until the problem is impairing? But often impairment is an element that prompts clients to ask this question of their situation.

By impairment, clients often mean, “Does the problem cause problems in my personal or professional relationships? Does it prevent me from activities of daily living or generally taking care of myself or others I for whom I am responsible? Does it detract from my career or work output? Does it prevent me from sleeping or thinking clearly?” These questions represent impairment across different domains of life. While we provided several examples here, there could be no significant impairment or impairment in just one or many domains that drive a client to determine that a problem warrants professional help.

“How do I use my subjective experience of mental wellbeing to tell me if I’m ‘better’ now?” 

Well, subjective wellbeing is an important predictor of resilience, medication adherence, and contributes to recovery (Nagata et al., 2025). It’s not just a test to see if you’re “cured” or recovered – it’s great the whole way through therapy. If anything, people should make more use of subjective wellbeing throughout therapy, not just at the start and finish. 

Whether it indicates full recovery depends on one’s philosophy of recovery. Many clients feel improvement despite having a few symptoms still, and, even with a few symptoms here and there, may not meet criteria for a diagnosis anymore. One philosophy of recovery suggests you can’t have recovery without symptom reduction (usually to subclinical levels.) Another blends together symptom reduction with subjective wellbeing to determine if recovery has been achieved. It seems like neither one (symptom reduction or subjective wellbeing) is a sole determinant of recovery. For example, feeling greater subjective wellbeing, but still experiencing some symptoms that raise safety concerns may suggest that person should keep going with therapy and continue improving in order to reduce risk of harm to themselves. On the other hand, simply stating that someone no longer meets criteria for a disorder, but they subjectively still feel unwell also suggests there is unmet need for healing. Neither by itself seems like it gives the full picture of recovery, so using both together is likely the best call.

“What criteria does the DSM-5-TR require to make a diagnosis?” 

The DSM-5-TR includes criterion B, “The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning,” which is very close to how clients often think of problems. (Note, not all diagnoses in the DSM have a clinical significance criterion.) This clinical significance feature was originally introduced in the DSM-IV in an attempt to reduce false positives – or inaccurately giving someone a diagnosis they do not actually have – but this was not an evidence based choice so we lack data to tell us what effect (if any) this criterion has (Spitzer & Wakefield, 1999.) 

In a nutshell, the DSM-5-TR combines symptom clusters and the presumption that a clinician has at minimum done either a structured or unstructured clinical interview and has assessed the data provided by the client and come to a conclusion using the data and their clinical judgment. In this case, clinician judgment is a big determinant of what constitutes clinically significant. Sometimes clinicians incorporate self-report or neuropsychological measures to help make this judgment.

The DSM-5-TR includes a few extra details to exclude “normal” emotional responses to life stressors (e.g., feeling sad after the death of a loved one) and emotional or behavioral symptoms of medical illness or substance use. 

Sources

Nagata, S., Yamaguchi, T., Sassa, T. et al. Sport for Recovery from Psychiatric Disorders: Psychosocial Outcomes and Factors Contributing Subjective Well-Being. J. Psychosoc. Rehabil. Ment. Health (2025). https://doi.org/10.1007/s40737-025-00488-6

Spitzer, R. L., & Wakefield, J. C. (1999). DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem?. American Journal of Psychiatry, 156(12), 1856-1864.