The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) goes on sale on May 22 after more than a decade of revision by 1,500 experts.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) goes on sale on May 22 after more than a decade of revision by 1,500 experts. As the bible of psychiatry, it is enormously influential. Based on its diagnoses, patients will be able to claim sickness benefits, insurance and compensation. Drug companies can market new products. Odd behaviour will become a medical problem.
The purpose of DSM-5 is to enable doctors to make more reliable diagnoses of mental disorders by setting strict criteria. But most of the commentary that has accompanied its launch has been negative. As The Economist notes, “In the eyes of many critics it is a vehicle for misdiagnosis, overdiagnosis, the medicalisation of normal behaviour and the prescription of a large number of unnecessary drugs.”
The new edition adds to the ever-expanding number of diagnosable conditions: disruptive mood dysregulation disorder (children’s tamtrums), excoriation (skin-picking) disorder, hoarding disorder, binge eating disorder and grief at the death of a loved one. By one calculation, half of Americans will experience a diagnosable mental illness in their lifetime.
The critics of the new edition include the chairman of the last edition, Allen Frances. He claims that DSM-5 “includes new diagnoses and reductions in thresholds for old ones that expand the already stretched boundaries of psychiatry and threaten to turn diagnostic inflation into hyperinflation”.
Thomas R Insel, director of the National Institute of Mental Health, the leading US government’s agency for mental illness has attacked the manual’s “validity”. “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”
And the Division of Clinical Psychology, an eminent UK body, wants doctors to abandon psychiatric diagnoses and to develop alternatives which do not use the language of “illness” or “disorder”. It says: “Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias.”
Every edition of the DSM has attracted strong criticism. Perhaps the ultimate reason is that the mind is a still a mystery. Psychiatrists have fundamental differences over how to explain mental illness: is it purely biological? Is it due to social stresses? Does it exist at all? No doubt they will be arguing just as heatedly over DSM-6.
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