Concerns with the DSM-V

Janet Greider
Overview

With 16 years of scientific and technological advances between the DSM-IV and the DSM-5, there are some significant changes between the DSM-IV and the DSM-5. In other sections of this blog, we’ve noted these differences in the structure, some additions and re-classifications of diagnostic criteria, and highlighted the voices and rationale behind the Asperger’s Syndrome vs. Autism Spectrum Debate.

However, not all the proposed changes to the DSM-5 are popular.

Concerns with the DSM-5

The Society for Humanistic Psychology (Division 32 of the American Psychological Association) is one of the many groups that challenge the proposed diagnostic criterion, as well as the DSM-5 Task Force’s methods.

In a letter from the Society for Humanistic Psychology (Division 32 of the American Psychological Association) to the DSM-5 Task Force on November 7th 2011, the Society highlighted what they felt were the most relevant concerns present in the DSM-5 currently:

  1. Lowering diagnostic thresholds, which can artificially inflate the prevalence of disorders and the number of people who qualify for medicalization or stigmatization.
  2. The lack of scientific evidence supporting many of the newer proposals.
  3. The consequences new disorder categories may have on vulnerable populations (children and elderly) due to inappropriate treatment with medications that contain dangerous side effects.
    1. Specifically the overuse of medications for
      1. “Attenuated Psychosis Syndrome” (new to the DSM-5)
      2.  “Disruptive Mood Dysregulation Disorder” (new to the DSM-5)
      3. “Mild Neurocognitive Disorder” (new to the DSM-5)
      4.  ADHD
      5. Generalized Anxiety Disorder

Rationale for Concerns with  DSM-5Development

The Society argues that while the field trials have large and diverse sample sizes, most lack the contribution of multiple independent researchers over time, as well as replication. Consequently, the newer diagnoses added to the DSM-5 on the basis of the results of the field trials may simple be place holders that will inflate the overall quantity of diagnosable disorders.

In tandem with an increase in the overall quantity of diagnosable disorders, the Society encourages the Task Force to remember that the social consequences of including diagnoses in the DSM will impact all of society, from stigmatization through to excessive and inappropriate medication, resulting in overall higher health care costs that are in some cases unmerited.

The Society for Humanistic Psychology, representative of is not alone in this viewpoint.

Chair of DSM-IV (Allen Frances) Opposes Development Methods of Chair of  DSM-5 (David Kupfer)

Dr. Allen Frances, who chaired the development of the DSM-IV, has adamantly opposed the direction the DSM-5 is taking. While the chair of the DSM-5 (David Kupfer) has lauded the changes in the DSM-5 as a ‘paradigm shift’ in psychiatry, Dr. Frances argues that there are no lab tests for the new diagnoses, and the method of developing the DSM-5 has “displayed an unhappy combination of soaring ambition and weak methodology” (psychiatric times, 2011).

Like many others, Dr. Frances is concerned about the DSM-5  adding diagnoses that will fill the bill for pharmaceutical companies that have developed ‘cures’, and are just waiting for diseases to fit their cures.

The pharmaceutical companies are talented lobbyists and have plenty of money to support their arguments.  With many new diagnoses added to the DSM-5, and lowering thresholds of diagnostic criteria across the categories, many worry that the DSM-5 will support a ‘paradigm shift’ that favors the pharmaceutical companies economical goals.

DSM-5 has the Broadest Base of Disagreement and Discussion for DSM in History.
 Why? Technology

Other groups and individual clinicians have also voiced their concerns over the limited access the public has to the methods and rationale for the inclusion or exclusion of a diagnostic criteria in the DSM-5, and some have taken their concerns away from the official comment board of the DSM5.org to external blogs and venues. In fact, this is the most widely-discussed version of the DSM-5 outside of academic papers ever. It is a tantalizing look at how future publications of the DSM will be written, edited, and reviewed (for the development of the DSM-6 is already being considered in the later stages of the DSM-5).

Attached is an example of how technological advances will are spurring discussion on the development of the DSM-5. This podcast is reviewing the new diagnoses of the DSM-5, including internet addiction disorder (which has been dropped from the DSM-5 since 2009), Expanded ADD and GAD criteria, and temperament dysregulation disorder. As an archived podcast on a webpage, it is accessible to any user at any time. This ability represents a revolution in the discussion and dissemination of information about the DSM-5.

http://www.beforeyoutakethatpill.com/index.php/2011/11/15/podcast-dsm-5/

 

References:
Elkins, D., Robbins, B.D., Kamens, S.R. (2011, Nov 7).  Response to Letter from DSM-5 Task Force and the American Psychiatric Association. [Society for Huanistic Psychology Division 23 of the American Psychological Association]. Retrieved from http://societyforhumanisticpsychology.blogspot.com/2011/11/response-to-letter-from-dsm-5-task.html

Bremner, Doug. (2009, June 23). DSM-V Shadow Team: Retaliations & Beware of Consequences. [Before You Take that Pill]. Retrieved from http://www.beforeyoutakethatpill.com/index.php/2009/06/23/dsm-5-beware-of-consequences/

Janet Greider

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