So, by now many have heard the American Psychological Association has finished it’s current revisions to the Diagnostic and Statistical Manual of Mental Disorders, the DSM. The DSM, in the US, is the standard by which conditions are coded, and therefor recognized, and approved as reimbursable.
Granted, you cannot make everyone happy, but I am not a fan of many of these changes and am left to wonder what the real point of this revision is.
A proposed change I did like, which seems to have made it into the final approved draft, was the scaled coding of personality disorders such as narcissism, but I don’t know if the final version was as comprehensive as the draft. However, the old PD diagnostic criteria were left as is despite the need for changes.
A proposed change I wanted to see was for a better diagnostic criteria relating to childhood trauma, especially that of an ongoing nature, and the resultant stress. PTSD does not begin to cover this effectively. I hope the newer model is more accurate, yet I know it falls short of what child trauma experts report as neeeded.
Getting rid of the grief bereavement exclusion seems very likely to lead to greater depression diagnoses and therefore medication instead of allowing for normal healing after loss. Similarly, medicalizing child tantrums also seems to lead down a path of greater diagnoses and more therefor more treatment, likely with medication. How does medicalizing a tantrum, a normal child behavior, help a child or a family? Perhaps what’s needed is simply more focused parenting with structure and consistent rules, something sorely lacking in my community, and in our society.
I am concerned about the elimination of Asperger’s and Dyslexia, and grouping these within Autistic Disorders and Learning Disorders, respectively. There is a real potential to increased difficulty in diagnosing and therefore acquiring services through schools, and this is all ready a difficult task in too many districts.
One of my biggest questions is why are we not just using the International Statistical Classification of Diseases and Related Health Problems (IDC)? If it is the official system for the US, and recognized by Medicare and Medicaid, why do we need a distinct DSM when the IDC covers mental and behavioral disorders, and that version is international in scope, and therefore in research and knowledge base?
For further reading on the changes to the DSM, the link on the title will take you to an interesting article in Psychology Today, The DSM 5 Is a Guide Not a Bible-Ignore Its Ten Worst Changes.
And for a nice info-graphic, use this link.
Our authors want to hear from you! Click to leave a comment
Great piece Michelle, I agree that this update is a double edged sword at a lot of points. It would be great to hear from someone who might have some inside information about the motivating factors surrounding those particular changes.
As far as I know it’s the American Psychiatric Association that originally came up with the DSM and that is updating its revision. A major difference and one of the reasons why the DSM is getting more and more medicalized. Psychologists could not write a Manual that would recommend any kind of medication, for the same reason that Clinical Social workers cannot. They did not go to medical school. Only doctors and now physician assistants under the supervision of a doctor can prescribe meds. I also think that it is the reason why we do not use the IDC. It is less restrictive and less dependent on medication. As a matter of fact in most European countries the IDC is not used by neither psychologists or social workers. Why? because it is a medical diagnostic tool. Also your links do not lead to any article in Psychology Today and one of them links to what I consider a fishy commercial site. Other than that, I absolutely agree with everything you write. It’s tragic that we start medicating children instead of using regular and time tested educational and socialization roles. Doctor are like hammers. To hammers, everything looks and is treated like a nail. Doctors see everyone as a potential medication taker or surgery patient. Isn’t that what they are trained in? It’s unfortunate that we have to follow their tools and more unfortunate because their answers to conditions vary so much from ours. I did not know that the IDC was the document recognized by the Us and by Medicaid and Medicare. Are you sure. If that were to be the case we would have to know both systems to fill out paperwork for these government agencies and it’s been my experience that we use the DSM.
Courtney, I can tell that the reason the 5th edition came out was because the original group of doctors on the panel that was to make the alterations were under the payroll of big Pharma and got caught. It was a small scandal at the time, forgotten already. Those changes are still heavily influenced by the pharmaceutical companies that have it in their interests to medicate everyone. They don’t make any money with therapy or other medication approaches. Do not get me wrong. I am not against medications and as a matter of fact I think that the control certain organisms like the DEA have on doctors is pathetic and misguided. But to me there are many behaviors that have been part of the human condition for a very long time, at least speaking from a Western culture perspective and to start medicating them is absurd and dangerous. Sorry about this long winded post.