DSM-V: new diagnostic manual coming out: What are its implications for psychotherapy in Chico?
May 2013: the DSM-V, the new Diagnostic Manual for Psychiatric disorders is a fact. This new manual has been highly controversial as its scientific basis is quite problematic and as the APA has refused to an independent review of this new manual. The field testing step that was needed for quality control was skipped. This is not an acceptable approach to prepare and approve a diagnostic system. Allen Frances, MD, chairman of the DSM-IV task force and professor emeritus at Duke states:
'Psychiatric diagnosis has become too important in selecting treatments, determining eligibility for benefits and services, allocating resources, guiding legal judgments, creating stigma, and influencing personal expectations to be left in the hands of an APA that has proven itself incapable of producing a safe, sound, and widely accepted manual.' He also states that new diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs - often after short visits with primary care doctors.'
One of the concerns in this new manual is that typical, and normal human behaviors become pathologized. This will eventually lead to an inflation in psychiatric diagnoses. Someone who is mourning the loss of a loved one might qualify for the diagnosis of Major Depressive Disorder after 2 weeks of qualifying symptoms, and might be prescribed psychotropic medication. This way, necessary, human emotional responses to loss become trivialized and medicalized. Common forgetting typical for old age becomes pathologized with the new diagnosis of Minor Neurocognitive Disorder. Allen Frances points out that this might lead to a lot of anxiety in people for no reason, as those people who will receive this diagnosis are not necessarily at risk for dementia. Excessive eating 12 times in 3 months becomes 'Binge Eating Disorder' and is not just gluttony anymore...
For the younger population, temper tantrums are made into a mental disorder: Disruptive Mood Dysregulation Disorder. This seems a careless decision for a couple of reasons: for one this this is a decision based on the work of only one research group. It also seems careless as it might lead to a new fad in child psychiatry with an increase in inappropriate use of medications in children. Over the recent decades child psychiatry has seen already seen a tripling of ADD, an increase of more than twenty times in Autistic Disorder and of forty times in childhood Bipolar Disorder.
DSM-V does try to reign in the Autism 'epidemic' by introducing more strict diagnostic criteria. This will make the diagnosis more specific. However, advocate groups understandably get concerned here as this might mean that children who were on the higher end of the Spectrum, and previously diagnosed with Asperger's syndrome, (which is eliminated in DSM V) might not qualify for services anymore...
The number of labels and psychiatric disorders have multiplied exponentially over the last editions of the DSM. What was normal before is pathology today. There are multiple problems with this. Within the context of my clinical practice one of the most significant concerns is that people see the label as The answer to what has been puzzling them in their own behavior or that of their child. They hope that the medication prescribed for the diagnosis will bring the hoped for solution. I do believe that the label could be a tool in getting a child or person the help he or she needs, but I also strongly believe that this label should never be the last word, it should never allow us to stop thinking, understanding, listening... Unfortunately, often time the label ends up being the last word, and the medication shuts up further speaking. This has been happening with the ADHD diagnosis for many children, and it could be that the new diagnosis of Disruptive Mood Dysregulation Disorder will be another instrument in silencing children without taking the time to listen to them.
For more information on the changes of the DSM-V and critique I refer to Allen Frances' book: