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Manual of Mental Disorders Flawed?

Additions and revisions to a diagnostic guide used by mental health professionals around the world could lead to more misdiagnoses.

By | November 3, 2011

DREAMSTIME, ALEKSANDER LOBANOV

There is widespread concern about the revisions to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) among mental health professionals, Nature reported. After psychologist David Elkins of Pepperdine University in California posted an online open letter in October warning that the revisions might elicit a slew of misdiagnoses and unnecessary medication prescriptions, among other things, 2,800 people signed it in support.

Specifically, professionals worry that the diagnostic guide, which will be published in 2013, contains new disorders as well as some changes to the definitions of existing mental conditions that could lead to clinical diagnoses of people exhibiting normal behaviors Critics claim, for example, that instead of modifying the criteria for attention deficit and hyperactivity disorder (ADHD) and bipolar disorder—something healthcare professionals have been calling for in order to control the number of diagnoses made in children—the DSM-V added a new disorder called “disruptive mood dysregulation disorder,” which can be used as an alternative diagnosis. Another planned addition is “attenuated psychosis syndrome,” which could be used "to stigmatize eccentric people," the British Psychological Society wrote in a letter critiquing the new edition. The results of field trials of DSM-V will be published in the near future and will reveal whether the new and revised criteria will lead to increased diagnoses, according to Nature.

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Avatar of: Dr. A-F

Dr. A-F

Posts: 1

November 12, 2012

The fundamental scientific flaw in the Diagnostic & STATISTICAL Manual of Mental Disorders is that never has the APA had the professional courtesy of providing professionals in every other field who might depend on the DSM for evidence-based care with the quantitative "statistics" that provides the objective evidence that supports the DSM diagnoses. I recently wanted to respond to a mother who wanted to know what the statistically grounded incidence was of ADHD. I had to go to the CDC only to find qualitative results on "times ADHD was diagnosed" (a sampling reductio ad absurdum because members of the APA are the ones who use the DSM and they can be expected to respond according to what their own Manual tells them), or results on a  "parents and teachers" paper-and-penil test. At the very least, in a period of evidence-based medicine - meaning that the DSM should "stand up in Court," which it does not - the DSM's Dxs should be based on a national probability sample NOT conducted by the APA but an independent third party demonstrably qualified in quantitative survey research and specifically conducting national probability samples, because if our good psychiatric colleagues don't know it, it's the best way to eliminate bias.

Dr. A-F

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