Question: Are personality quirks turning into disorders?
As science and society evolve, so do the psychological conditions that need to be identified and addressed.
The “Diagnostic and Statistical Manual of Mental Disorders,” or DSM, is a handbook published by the American Psychiatric Association that provides standard criteria and terminology for the classification of mental disorders.
The fifth edition of the DSM may not be due until 2013, but that has not stopped its first draft, which was posted earlier this week, from being verbally eviscerated by many members of the online psychiatric community and larger blogosphere.
Indeed the Internet is a cruel mistress from whom to seek peer review, but when dealing with a document designed to be held as the focal point of the industry’s referential dogma it is perhaps a most necessary torment.
Regardless, many believe that it would be better to just abandon the DSM revision altogether rather than using the three-year window as an opportunity to modernize its contents.
“Strong sentiments will always accompany changes in the diagnosis of mental disorders,” said Manuel Barrera, head of ASU’s clinical psychology program. “Mental illness diagnosis is controversial even without changes to the diagnostic system. I am suspicious of claims that the sky is falling, particularly since information up to this point has not been good.”
One of the largest concerns of such individuals is that the updates could even further inflate America’s daunting rate of psychiatric over-diagnosis through the inclusion of such new disorders as binge eating.
While a valid concern, this logical path is both counterproductive and guilty of placing the blame on the DSM rather than the true sources of over-diagnosis: psychiatrists and the Americans who seek the treatment in the first place.
According to an article by Eve Kupersanin of Psychiatric News, the official newspaper of the American Psychiatric Association, outpatient treatment of depression more than tripled between 1987 and 1997.
“In addition, of those treated for depression, 44.6 percent were prescribed a psychotropic medication in 1987, compared with 79.4 percent in 1997,” according to Kupersanin.
The article attributes these drastic increases (which are expectedly much higher now, more than a decade later) to “the public’s growing awareness about effective treatments and the decline in stigma surrounding mental illness.”
While the DSM serves an important purpose for doctors and psychiatrists in treating their patients, this role is not to serve as law but rather as a general guide for use in patient diagnosis.
“As with the Bible,” said a recent L.A. Times editorial, “in some cases the manual should be taken not literally but seriously.”
Instead of dragging our feet along, pointing fingers irresponsibly in all the wrong directions, it is important for experts to focus their efforts on making DSM-V as practical as possible for the professionals who intend to use it and the patients they intend to diagnose — for sanity’s sake.
Hal looks optimistically toward 2013. Prescribe him your thoughts at hscohen@asu.edu
