DSM-5 and the diagnosis controversy Matt Jarvis

DSM-5 and the diagnosis controversy The DSM system The DSM is the Diagnostic and Statistical Manual of Mental Disorders. It is published by the American Psychiatric Association. It is one of the most commonly used systems worldwide. The aim of DSM is to have a comprehensive system for classifying and diagnosing mental disorder.

DSM-5 and the diagnosis controversy Why the fuss about DSM-5? DSM-5 has been ‘live’ since May For those familiar with DSM-4, there are some important general changes: There is no longer a distinction between clinical disorder (formerly axis 1), personality disorder (formerly axis 2) and general medical conditions (formerly axis 3). Nor is there now a global score of how well a person is functioning. Instead patients are assessed on the following:  symptom severity  danger to self or others  ability to care for self  ability to function socially

DSM-5 and the diagnosis controversy The real controversies around DSM-5 are not so much around these structural changes as with the blurring of boundaries between normal and abnormal behaviour. For example: A bad temper can now be diagnosed as ‘disruptive mood dysregulation disorder’ Grief can now be diagnosed as ‘depression’ Mild forgetfulness can now be diagnosed as ‘minor neurocognitive disorder’ Sex and internet addiction can now be diagnosed Anxiety disorders are much more likely to be diagnosed More controversial changes

DSM-5 and the diagnosis controversy The impact of these changes Some mental health professionals fear that very normal behaviour, ranging from temper tantrums in toddlers to age- related forgetfulness, will now be ‘medicalised’. Unnecessary anxiety will result as people see normal behaviours as ‘illness’ More people will resort to medical treatment unnecessarily

DSM-5 and the diagnosis controversy The really cynical view… Some commentators have noted that the changes to DSM are likely to result in a large increase in the prescription of psychiatric drugs. Most of the DSM-V committee have close connections to drug companies.

DSM-5 and the diagnosis controversy Challenging the idea of diagnosis So should there be diagnosis at all? In 2013 the British Psychological Society’s Division of Clinical Psychology issued a position statement calling for the end of the ‘disease model’ of mental health problems for two main reasons. There are flaws with the whole concept of mental illness, including poor reliability and validity, overemphasis on biology and bias towards a white, Western world-view. The current system disadvantages patients by marginalising and disempowering them and by fostering negative self-image and encouraging discrimination by others.

DSM-5 and the diagnosis controversy Conclusions Both the DSM-5 and diagnosis and classification in general are highly controversial. There are particular issues with DSM-5 because it seems likely to increase the number of people receiving diagnoses and taking drugs as a result. There are serious issues with the whole idea of diagnosis, as explained by a recent position statement from British clinical psychologists.