Table 2

Implications of alternative viewpoints regarding accepting or rejecting states of being as diseases

Categories of states of being Examples	Disease?	Conceptualisation	Implications for action	Potential negative consequences/ramifications
Addictions or possible addictions Alcoholism Drug addiction Gambling addiction Obesity Smoking	Yes	Biological health disorder	Harm reduction Public funding Medical treatment	Focus on individuals and treatments may cause social and moral aspects to be ignored8 43 44 47
	No	Lack of self-control Moral failing	Abstinence through individual choice and self-discipline Punitive management strategies	Stigma and discrimination, neglect of harm reduction, neglect of social causes, increased suffering for the population40 42–44 46 48
	No	Social problem	Preventive social solutions: income redistribution, poverty reduction, education, social marketing	Effective medical treatment underused42 43
Medical diagnoses with uncertain biological/psychosocial basis Chronic fatigue syndrome Fibromyalgia Irritable bowel syndrome Panic disorder Personality disorder	Yes	Specific biological problem	Diagnose and treat, possibly with drugs	Overdiagnosis and overtreatment with drugs, undertreatment with behavioural approaches11 15 16 31
	No	Socially mediated adjustment problem	Behavioural therapy Modify environment	Patients may feel stigmatised Effective medical treatment may be underused11 16 49
Diminished function or altered appearance, often age-related Age-related muscle loss Baldness Erectile dysfunction Lack of sexual desire	Yes	Biological health disorder	Diagnose and treat, possibly with drugs Public funding	Overdiagnosis and overtreatment Medicalisation of society, with increased self-perception of illness and poorer coping with suffering that is part of life11 15–17 49
	No	Normal consequence of living	Accept and adjust Responsibility on individual	Neglect of treatments that may reduce suffering and improve function11 16 49
Patterns of behaviour Homosexuality Obesity Smoking Transsexualism	Yes	Biological health disorder	Diagnose and treat, possibly with drugs Negative social stigma	Adverse judgment and resulting stigma and discrimination53
	No	Lifestyle choice	Respect person's choice	Permissive attitude encourages self-destructive or morally reprehensible behaviour43 Underuse of effective treatment34
	No	Moral failing	Abstinence/modification of behaviour through individual choice/self-discipline Punitive strategies	Stigma and discrimination53
Syndromes or constellation of patterns of symptoms of unclear basis Attention deficit hyperactivity disorder Fibromyalgia Overactive urinary bladder Panic disorder	Yes	Essentialist: specific biological disorder	Label all patients with specific category and treat uniformly	Failure to recognise diversity of illness, excessively uniform management, stifle research that could deepen understanding2 5 51
	No	Nominalist: collection of symptoms, signs, behaviours, label of convenience	Acknowledge syndromes as convenient constructions, seek underlying causes, don't attempt to pigeon-hole unusual presentations	Acknowledgement of complexity may lead to inefficiency, paralysis2 5 51

*Negative consequences listed here refer particularly to smoking and obesity not to homosexuality and transexualism.