Monday, May 6, 2013

Controversy over the New Psychiatric Diagnostic and Statistical Manual

Since 1952, the American Psychiatric Association has published the Diagnostic and Statistical Manual of Mental Disorders (DSM for short) which has spelled out the criteria for diagnosing all of the known psychiatric disorders.  It has undergone four editions and two revisions with the fifth one due out this year.  In the past there were controversies such as whether or not homosexuality should be included in the manual and it was dropped from the DSM in the 1970s.  New changes are made to the manual as new information is brought to light and cultural views of what is and what is not a disorder change.

This year the fifth edition of the DSM proposes changes to 13 current diagnoses.  The most controversial of these is Asperger's Syndrome which is being eliminated as a separate diagnosis and is being placed under the  Autism spectrum of disorders.  Unlike the gay community in the 1970s, has deletion been met with resistance by those who have been previously diagnosed with Aspergers.  Other changes have been made to dyslexia, ADHD and other diagnoses.  At least 10 new diagnoses are included in the DSM such as post-traumatic embitterment disorder, skin picking disorder, and compulsive hoarding (maybe the American Psychiatric Association all watches TLC). 

Previously the DSM has been accepted as the Bible of psychiatric diagnosis but, right before the DSM-V comes out the National Institutes of Mental Health (NIMH) has announced that it will not use it as a standard for diagnosis in their research.  This means that they will not be funding studies that use the DSM-V as a diagnostic criteria.   The reason given by the NIMH is that 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."  This suggests a desire for exactness which the behavioral sciences have lacked relative to the physical sciences sometime termed physics envy.

There have been advances in neuroscience and genetics which shed light on many of these disorders and made many pharmacological treatments possible but the main reliance for diagnosis is still on behavioral symptoms.  The NIMH is creating a Research Domain Criteria for Diagnoses (RDoC) based on biological criteria which it believes are more objective.  The behavioral symptoms are often subject to interpretation and often still not enough is known about the brain and genetics to differentiate between pathologies.  Consider the figure at left.  Is this a rabbit with its head held high or a duck?  This image is subject to interpretation just as all behaviors and incomplete scientific data are.  Science is fundamentally a human endeavor where politics often plays a role.  

**Related Posts**

ADHD, Genetics, and Causality: A Chicken-Egg Problem

Cause and Effect, Slip Slidin' Away

A Morsel of Mensa Measurement

We Need Slightly Unstable Leaders?

The Need for Exactness


  1. I am glad to see that the NIH has rejected this "Bible" of disorders. For years their identification of Bi-polar Disorder was used. Talk about an incorrect measure. I know individuals who were medicated up the wazoo and didn't have that disorder. Clinicians were quick to use it because it was trending. Psychiatry is at best so inexact, so subjective as to be a joke. If you do not hold the same values as the psychiatrist/psychologist, then they could be advocating practices for your mental health that are the antithesis of what creates mental health. If they are not spiritual, do not acknowledge that humans have a soul, then what's the point? The science of psychology is NOT a science, it is even less than what medical science allows for empirical studies, as medical science skews research to please its own hypotheses. Very rarely are longitudinal studies done, very rarely and those are the most telling. Of course, there is the longitudinal study, the infamous Tuskegee study where individuals-human guinea pigs, predominately black were allowed to wither away and go insane after being diagnosed with syphilis all in the name of science and medicine, this is after antibiotics were known to be a cure. So when you speak of science, medical, psychological, bring out Dr. Frankenstein...a lot of it is controlled by corporate interests, unscrupulous researchers, warped psychiatrists and wacked clinicians. Above all, what is mentally normal in our sick pop culture? Ha, ha. All is relativity...and in psychiatry, there is no such thing as evil. But when you don't acknowledge a soul or spirit, then you are eliminating what makes us human. Good night nurse. ;-)

    1. Thanks for your comment Carol. You raise a lot of important issues. There are pros and cons to defining and treating mental illness. What is normal anyway? There are some individuals who have difficulty functioning and need assistance. A method for identifying them and treating them is needed and it is important to make it as accurate as possible.