- Geoff Watts
Although not due to be published until May 2013, the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is already provoking dissent among psychiatrists and psychologists in Britain. Critics claim it will make an already problematic diagnostic system worse and result in more people being labelled mentally ill.
Producing a new edition of the DSM is a major undertaking. This one, prompted by the accumulation of new information on neurology, genetics, and behavioural sciences, has been compiled by the 162 members of 13 separate work groups, helped by a further 300 advisors and informed by many open meetings.
All this effort has failed, however, to create unanimity. “The new categories are based on lists of symptoms that don’t necessarily map well on to the underlying biological and psychological processes involved in emotion, behaviour, and cognition,” said Nick Craddock, professor of psychiatry at Cardiff University.
Speaking at a critical briefing on the current plans for the DSM-5 he claimed that more aspects of emotion, behaviour, and cognition are going to be labelled as diagnoses. This will medicalise more of what most people view as normal human behaviour.
He offered the example of someone having an episode of severe low mood that met the accepted diagnostic criteria of depression. “Currently, if this follows bereavement, it would be excluded. It would be regarded as normal. But in DSM-5 the plan is to remove the bereavement exclusion. What most would view as a normal reaction to the death of a loved one would be labelled as a depressive illness,” said Professor Craddock.
Peter Kinderman, professor of clinical psychology at the University of Liverpool and also speaking at the briefing said, “DSM-5 is making the process of describing and explaining situations worse.” He gave as an example the diagnosis of gambling disorder. “For individuals and for society gambling is a problem. I think it’s unhelpful to regard it as an illness,” he said.
“The proposed revision will include a vast number of social, psychological, and behaviour problems in the category of mental disorder, so pathologising mild eccentricity, loneliness, shyness, sadness, and much else. One worries about what this will mean for the person who receives the label.” To be categorised as mentally ill has all sorts of consequences, he added.
Professor Kinderman suggested that “the American Psychiatric Association call a halt and convene a representative international expert panel to discuss the proposals.” This is a wasted opportunity, he said, because there is a genuine need to reconsider psychiatric diagnosis.
Both speakers talked in their capacity as individual practitioners. But Professor Craddock said, “I believe that a large proportion of psychiatrists in the UK and Europe would be as sceptical as I am.” So too, he added, would psychologists.
Categorisation of the kind proposed for the DSM-5 might be more appropriate in the US where a medical diagnosis is often necessary to qualify for reimbursement for the costs of treatment. But even in its home country it is not finding universal approval.
Cite this as: BMJ 2012;344:e1020
Monday, February 13, 2012
Critics attack DSM-5 for overmedicalising normal human behaviour | BMJ