DSM-5 Changes: A Continuation

I continue to come across articles and information regarding the soon to be released DSM-5. Reading this link will provide quite a bit of information on the upcoming changes to the DSM. I have to wonder if our society is becoming too focused on a diagnosis and pharmacare.

“After the American Psychiatric Association (APA) approved the latest version of its diagnostic bible, the DSM-5, psychiatrist Allen Frances, the former chair of the DSM-IV task force and current professor emeritus at Duke, announced, “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry.”

That statement alone says it all especially coming from a psychiatrist.

“Get ready to hear about a new mental illness diagnosis for kids: ‘disruptive mood dysregulation disorder‘ (DMDD)… Frances concludes DMDD “will turn temper tantrums into a mental disorder.”

“What constitutes binge eating disorder? Frances reports, ‘Excessive eating 12 times in three months is no longer just a manifestation of gluttony and the easy availability of really great tasting food.’  DSM-5 has instead turned it into a psychiatric illness called binge eating disorder.” 

The DSM-5 also brings us ‘minor neurocognitive disorder’ — the everyday forgetting characteristic of old age. Francis states, “Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia.”

“First time substance abusers will be lumped in definitionally with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.” DSM-5 also introduces us to the concept of “behavioral addictions,” which Frances points out “eventually can spread to make a mental disorder of everything we like to do a lot.”  And Frances adds that “DSM-5 obscures the already fuzzy boundary between generalized anxiety disorder and the worries of everyday.”

What about grief and bereavement which are also re-categorized in the upcoming DSM? Normal human grief, which I covered in another write-up here on SJS becomes yet another diagnosis: “In removing the ‘bereavement exclusion’, the DSM-5 encourages clinicians to diagnose major depression in persons with normal symptoms of bereavement after only 2 weeks of mild depressive symptoms.” Grief usually runs its course within 2-6 months and typically does not require treatment with medications. In addition:

The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.

Much of what I have read from parents and professionals is concern that the new definition of autism in the DSM-5 will exclude many people from both a diagnosis and state/provincial services that depend on a diagnosis.

The DSM has been looked at over the years, changes made by dropping diagnoses and creating new ones, but to what benefit? Studies that have been done over the years have caused some embarrassment regarding the DSM. For example, Read further about the 1973 study. In the study Eight pseudopatients were sent to 12 hospitals, all pretending to have this complaint of hearing empty and hollow voices with no clear content. All were able to fool staff and get hospitalized.

The 1980 DSM-III was dramatically changed to include concrete behavioral checklists and formal rules to solve the diagnostic reliability problem, hmmm…did it work?

I have the DSM-IV at a cost of $95 in 1995, and used it in graduate school and then professionally for 1 1/2 years with children. I had to choose a diagnosis for the insurance companies to pay for the therapy and treatment that was being provided and it had to be a diagnosis that the insurance company agreed with. I am not a fan of labeling people, especially children, as the diagnosis follows them around for many years if not their entire life. A label does not define a person, but unfortunately many become their label.

Should we focus more on treating the symptoms and less on the diagnosis? Are there alternatives to pharmacare? What changes can be made in the classroom or work setting to assist the person best? Have many of these diagnoses been created for insurance reimbursement purposes, especially when considering the new ones? Are everyday life choices and events being turned into a diagnosis?

The suggested price for the new DSM-5 is $199.00! That is one expensive book.

Written by Victoria Brewster, MSW
SJS Staff Writer in Canada