DSM V: A Plea For Skepticism

We are about to embark on new psychiatric diagnoses, as there is soon to be a revision of our current Diagnostic and Statistic Manual (DSM). This new reference book is creating quite the stir. In 1999 a DSM V Reserach Planning Conference sponsored jointly by APA and the National Institute of Mental Health was held to set the research priorities. The DSM V task force was established in 2007 and it consists of 27 members. In June, 2009 Allen Frances, head of the DSM IV task force, issued the criticism that that DSM V will cause "false epidemics". He wrote that "the work on DSM V has displayed the most unhappy combination of soaring ambition and weak methodology".

Psychiatric diagnoses are made by committee. The Diagnostic and Statistical Manual is published by the American Psychiatric Assocition and provides diagnostic criteria for mental disorders. It is used in the United States, and to varying degrees around the world by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. It was first published in 1952 and there have been five revisions. The last publication was DSM-IV published in 1994, although there was a text revision produced in 2000. The next edition is scheduled to be released in May, 2013. Another classification systems is the mental disorders section of the International Statistical Classifiction of Diseases and Related Health Problems (ICD). This is used more often in Europe and other parts of the world.

The DSM provides the definitive word on what is and is not a mental illness, with enormous influence within medicine and the world beyond. The elimination of homosexuality as a mental illness in the third DSM edition issued in the 1970s, for example, is now widely viewed as a watershed development in changing society's view from outright hostility to varying degrees of acceptance.

The biases of psychiatric diagnoses are powerful. The more people who are included in a mental disorder, the more research money there will be to fund the science, and the more drug companies have incentive to produce treatments. On the other hand, the more people who are included in a diagnosis, the more suspicious the public becomes about the quality of the diagnostic criteria. No matter how DSM V will be written, it will be flawed. There is no psychiatric diagnosis which has an objective measure. At the moment, all diagnoses are clinical diagnoses, meaning they are subjective. This is a field of humility. There is a lot that we do not know.

I think there should be an introduction to DSM V which clearly states that this book is a product of work groups, and as such, the diagnostic criteria are subject to further revision. Perhaps this is obvious, but I think that this point needs to be stated clearly. The public needs to know that psychiatry is a field in its infancy, and as such, skepticism is warranted.

http://blog.shirahvollmermd.com/