Let’s recap the DSM. How did we get here?
We wrote about the history of the DSM in an earlier blog post (http://www.healthyworkplaces.info/a-brief-history-of-the-dsm/). But it’s worth recapping some of the ‘good’ and the ‘bad.’ It’s not enough to say the DSM is scientifically unsound. We need to delve deeper than this and seek ‘full disclosure’ from critics.
What is inspiring Allen Frances, who was chair of the DSM-IV Task Force, to be so highly critical and lacking any contrition for his remarks? What is fueling boycotts of the DSM, including the most significant of these “Boycott DSM-5” (http://boycott5committee.com/)?
Susan Whitbourne, PhD, has provided a nice summary in the Psychology Today article “Fulfillment at any age” (http://www.psychologytoday.com/blog/fulfillment-any-age/201305/what-the-dsm-5-changes-mean-you) and we’ll take acknowledged liberty to summarize her key points here.
DSM-5 the good?
- DSM-5 is eliminating the five “axis” diagnostic system that requires clinicians to rate clients according to criteria other than their central psychological disorder, thereby freeing DSM users from understanding “axis” (dimension?) and the rather strange combination of personality disorders and “mental retardation” into one grouping.
- Eliminating the collection of unrelated disorders that ‘originate in childhood.’
- Stigmatizing is lessened by replacing stigmatizing terminology such as “Mental Retardation” with more accurate, some would say politically accurate, terms (“Mental Retardation” is now “Intellectual Disability”, “Hypochondriasis” is now “Illness Anxiety Disorder”).
- “Autistic Disorder” (now “Autistic Spectrum Disorder”) and “Asperger’s Disorder” are eliminated as diagnoses. The changes have rallied foul cries from many groups, but the move towards a spectrum concept potentially drowns out these cries.
- Karen notes “another good set of changes involves reorganizing and eliminating some disorders that no longer made sense in the new framework” citing “Obsessive Compulsive Disorder” fitting into its own grouping and not included with the anxiety disorders. PTSD is now part of “Trauma and Stressor-Related Disorders”, thereby ensuring the shared nature of these disorders.
New guidelines assist in evaluating suicidality. This will provide clinicians with a potentially more reliable and valid means of assessing risk of self-harm. It will also provide a better foundation for ensuring compliance with our professional ethics duties.
And speaking of “Schizophrenia”, clinicians may rate the severity of a client’s symptoms in more meaningful ways (note, we cannot say we agree with Karen’s trite remark ‘this is particularly good news for the legions of undergraduates who no longer have to memorize these somewhat confusing terms’).
DSM-5 the bad!
Including “Mild Neurocognitive Impairment” has a very real potential to pathologize normal age-related cognitive changes and “lead people with slight memory problems to rush to the conclusion that they have dementia.” We also note the rise of reported concussion-related head injury in sports and question whether the neurocognitive impairment in these situations would warrant classification as a mental disorder.
A general broadening of the “nosological net..making what’s normal seem sick.” For example, broadening the diagnoses of major depressive disorder (eliminating the “bereavement exclusion” where a grieving person has 2 months to experience sever symptoms of depression and not be pathologized.
Two new depressive disorders are introduced that some believe pathologizes temper tantrums: Premenstrual dysphoric disorder” and “Disruptive mood dysregulation disorder.”
The categorization system of personality disorders remains unchanged despite rallying cries for a dimensional system.
The majority of childhood disorders are reclassified, and some criteria broadened to the point of potentially including more children with mild or borderline symptoms (e.g. Attention Deficit Hyperactivity Disorder). “The problem with the relabeling, according to critics, is that it places emphasis on the biological causes of ADHD, minimizing the behavioral contributions. As a result, the critics maintain, people with this diagnosis may turn to pharmacological interventions instead of what many believe are the more effective (and side effect free) behavioral strategies.”
As Karen remarks in closing her commentary:
My advice is that you keep an open mind as you read articles in the press or in the self-help section of the Internet (this blog included). You have the ability to evaluate the evidence relevant to your own concerns. As they say, “talk to your doctor,” but in this case I would add “talk to your psychologist.” We’re listening.
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