Consequently, after brief comments on DSM-5's process and goals, I focus on DSM-5's false positives problem, arguing that this concern is largely justified and that DSM-5 was a missed opportunity to address this problem.įailure of the process to provide an adequate scholarly recordįor scholars trying to understand and evaluate the validity of the DSM-5 Task Force's decisions, the most important problem with the DSM-5 revision process was its secrecy and lack of adequate documentation. The ‘false positives problem’ of mislabelling normal condition as mental disorders is the issue that most impacts psychiatric epidemiology, given its heavy reliance on DSM criteria in community studies (Wakefield & Schmitz, 2010, 2011). Emblematic of this concern was the statement by Allen Frances, who had Chaired the DSM-IV (American Psychiatric Association, 1994) revision, that due to DSM-5's changes, ‘Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick…’ (Frances, 2012).
It was argued that the revised criteria illegitimately expanded psychiatric diagnosis into areas of normal-range distress and other problems in living, undermining the integrity of psychiatry as a medical discipline, obscuring the meaning of its research results and potentially leading to unwarranted and possibly harmful treatment. The most vehement and sustained objections were aimed at the content of its diagnostic criteria.
#Dsm 5 sample page manual
The fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) has been criticised for its revision process, goals and content. Introduction: the false positives challenge to DSM-5 I present four examples: increasing the symptom options while decreasing the diagnostic threshold for substance use disorder, elimination of the bereavement exclusion from major depression, allowing verbal arguments as evidence of intermittent explosive disorder and expanding attention-deficit/hyperactivity disorder to adults before addressing its manifest false positives problems. By expanding diagnosis beyond plausible boundaries in ways inconsistent with DSM-5's own definition of disorder, DSM-5 threatened the validity of psychiatric research, including especially psychiatric epidemiology. However, DSM-5's greatest problem, and the target of the most vigorous and sustained criticism, was its failure to take seriously the false positives problem.
The goals, such as dimensionalising diagnosis, incorporating biomarkers and separating impairment from diagnosis, were ill-considered and mostly abandoned. The revision process suffered from lack of an adequate public record of the rationale for changes, thus shortchanging future scholarship. The revision effort leading to the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was flawed in process, goals and outcome.