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Expanded Case Details

The DSM 5 has been subject to significant criticism for failing to consider the growing field of knowledge regarding the biology of mental disorders. For instance, the Director of the United States National Institute of Mental Health has criticized the revised manual for failing to incorporate an objective approach to diagnosis using cognitive testing, brain scans and genetic studies. Allen Frances, chair of the task force that developed the DSM IV, has outlined what he considers to be the ten most potentially harmful changes arising from the DSM 5 (see www.psychologytoday.com.blog/dsm5-indistress/2012). The article, based on the last draft of the DSM 5, was published on December 2, 2012). Dr. Frances’ criticisms included the following:

  • Normal grief on the death of a loved one may now be considered as a major depressive disorder
  • The everyday forgetting characteristic of old age may now be misdiagnosed as minor neurocognitive disorder, thereby creating a huge false positive population of people who are not at special risk for dementia
  • First time substance abusers will be lumped in definitionally with hard core addicts despite their very different treatment needs and prognosis
  • The introduction of the concept of behavioral addictions has the potential to make a mental disorder out of everything we do a lot – Frances cautions that we should be on the lookout for careless over diagnosis of internet and sex addictions
  • DSM 5 further obscures the fuzzy boundary between generalized anxiety disorder and the worries of everyday life. “Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.”
  • DSM 5 has opened the gate even further to the already existing diagnosis of post- traumatic stress disorder in forensic settings

Dr. Frances commented that the majority of the changes loosen diagnosis and threaten to turn current diagnostic inflation into diagnostic hyperinflation. He rejected the DSM committee’s claim that the document was a conservative document that would have minimal impact on the rates of psychiatric diagnosis and possible inappropriate treatment.

The British Psychological Society in the United Kingdom criticized the draft DSM 5 on the ground that it was in large part based on social norms, and that the symptoms on which the diagnoses relied often merely reflected “current normative social expectations.” It contended that mental disorders should be viewed on a spectrum that is shared with normality, and that recognition should be given to the psycho-social causal factors such as poverty and trauma.

The point is often made that the DSM approach is one that is not widely used outside of North America. For instance, a large number of European countries, including Britain, rely on guidelines published by the World Health Organization. For more information on the World Health Organization’s approach, see for example www.who.int/ (classification of mental and behavioural disorders) and www.who.int/substance_abuse/terminology//icd_10/en/. (classification of substance abuse disorders).

Advocates who are preparing to examine a mental health specialist may also be interested in reading Crazy Like Us: The Globalization of the American Psyche, New York: Free Press, 2010.

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