The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was published this year, and there was much rejoicing. There was also much controversy. As a budding psychologist, I was very excited to hear about the new edition of the DSM, but, in the months leading up to its publication, wading through the massive amounts of literature speculating what would be changed and what would remain the same proved to be confusing and time-consuming. All I gathered was that major changes could be coming in the near future, and they certainly have come.
Before you read on, I would like to convince you that this is actually important, even if you don’t think it is. The changes in this DSM will affect researchers, clinicians, the pharmaceutical industry, the legal system, and the general public. Let’s discuss how it will affect you, the general public. I’m certain you’re aware that homosexuality was once considered a mental disorder. That was in the DSM, until 1973. The DSM affects how the public views mental health, and therefore how we view those around us. People have access to the criteria for mental disorders in the DSM and may diagnose themselves or those around them, “[t]his amplifies the danger that too many people will receive psychiatric diagnoses,” according to Dr. Joel Paris of McGill University in his book, “The Intelligent Clinician’s Guide to the DSM-V.”
The first edition of the DSM was published in 1952, the second in 1968, but it wasn’t until the DSM-III graced us with its presence in 1980 that the psychiatric community could make use out of the tool. The DSM-III “increased reliability by taking an ‘atheoretical’ position,” making diagnoses “based on what clinicians can see and agree on, rather than on abstract theories,” according to Dr. Joel Paris.
After the DSM-III, no major revisions were made to the manual, until now. While going over the changes, what shocked me the most was the elimination of the multi-axial system of diagnosis. In previous editions each diagnosis was made using five axis incorporating different areas of the persons mental and physical health. The brings about two major changes in how we diagnose: the elimination of Axis V, which previously recorded level of functioning, and the incorporation of personality disorders (previously Axis II) into the realm of all other disorders.
First, this means that rather than being coded on a 0-100 scale of overall function, function can be rated using different scores for severity and disability. To me, this seems like a beneficial change. Functioning can be more precisely rated and more individualized to the client rather than having a person’s abilities being rated based on a simple score out of 100.
Second, this means that personality disorders are to be considered in the same way that any other mental disorder, such as schizophrenia and major depression, are considered. I am torn about this change. Personality disorders can be very destructive and negatively affect lives, especially anti-social personality disorder (think Ted Bundy and your friendly neighborhood felons).
The problem is that we suffer from over-diagnosis due to vagueness and vastness of criteria for most of the mental disorders covered in the DSM, in most cases, personality disorders have even more vague criteria and are much more difficult to conceptualize a physiological data-based diagnosis even in the more advanced future. I feel it may dilute the ability for the DSM to become a more data-based manual in the future, even if we can make data-based diagnoses for other disorders.
On the note of over diagnosis of disorders, another major change in this edition of the DSM is the expansion of criteria for some categories, notably generalized anxiety syndrome and attention deficit hyperactivity disorder (ADHD).
If I had a dollar for every person I heard complain about the over diagnosis of ADHD…I could maybe afford a tank of gas. Jokes aside, when children are being medicated for disorders they may or may not have, we have a serious problem.
Generalized anxiety disorder has similar ramifications, especially for people in college. College is a stressful time, but that doesn’t mean you need to be handed a prescription for Xanax. Prescriptions for ADHD and anxiety have a special penchant for being abused. The expansion of the criteria for what makes a person diagnosable in these cases is absolutely not a good thing.
If we didn’t have enough disorders to diagnose our children with, we can now diagnose overly aggressive children with disruptive mood disorder. Also, Asperger’s syndrome has been included in the range of Autism spectrum disorders.
However I am for the inclusion of Asperger’s in autism spectrum disorders, especially knowing that the range was kept limited (apparently some gunslingers wanted to expand that too).
The rest of the major changes consist of ways to classify certain disorders and different terminology to be used by clinicians (i.e., it’s even more boring than this stuff). Overall, it’s hard to come up with one opinion for the whole DSM-V. I am excited to see how these changes affect practice, and how it will change in the future.