Three Issues with DSM-5

Julie Shenkman
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Recently, the much-anticipated fifth edition of the "Diagnostic and Statistical Manual of Medical Disorders," or DSM-5, made its debut at the annual meeting of the American Psychological Association (APA). If you work in the mental health field, you must be aware of important changes to this diagnostic manual, as they could change the way you diagnose and treat patients with psychological disorders. Despite efforts to make it easier for patients to get the care they need, there is some controversy about some of the changes to the manual.

 

One of the biggest issues surrounding the release of the new DSM is that some problems traditionally considered normal are now being classified as mental health issues. For example, the grief experienced after a loved one passes away can now be classified as clinical depression. Seniors who occasionally forget things may be diagnosed with mild neurocognitive disorder. Critics of the new version of the DSM say that some members of the APA are promoting the use of medications for problems that are normal and do not need to be treated. Another example is binge eating that occurs weekly for at least three months. What the guidelines do not take into account is that someone could binge on junk food to cope with a breakup or the death of a loved one, and then stop the behavior on their own once they have worked through their feelings.

 

Another contentious issue is the fact that the DSM does not include Asperger's syndrome as a separate diagnosis. While Asperger's was previously categorized as a diagnosis, it is no longer listed in the DSM as such. People who had been diagnosed with Asperger's syndrome before these new guidelines took effect will be grandfathered into a more general new diagnosis, termed autism spectrum disorder, if their diagnoses were well established under the previous version of the DSM. These new diagnostic criteria will likely affect some patients' insurance eligibility or out-of-pocket costs for needed services; it will also limit the ability of healthcare providers to refer some patients to psychiatrists and other mental health professionals.

 

One of the major complaints about DSM-5, as with the previous four editions, is that the guidelines are based on rulings about what constitutes a symptom of a particular disorder. Critics say this makes for imprecise diagnostic criteria that do not fit every situation. The psychiatrists who issue the rulings do so based on research, but their own experiences also influence their decisions. When mental health professionals make incorrect diagnoses based on the criteria in the DSM, patients are unable to get the treatment they need.

 

The stigma of seeking mental health services keeps some people away from the medication and counseling they need, and some insurance companies make it difficult for patients to access mental health services. The new version of the DSM makes it easier to diagnose some disorders but harder to diagnose others. The new criteria may also make it more difficult for patients to qualify for the mental health services they need.

 

(Photo courtesy of freedigitalphotos.net)
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  • Melissa Kennedy
    Melissa Kennedy •
    Thanks so much. Errol, I tend to agree with you. The brain is such a mystery. Even with all of the advances we've made, there is still a large part of the brain we just don't understand. More research is needed.
  • GIORDANY B
    GIORDANY B •
    I inclined to the critics of this article against DMS-5. Many  healthcare practitioners try just to treat the symptoms   instead of the causes of the problems.
  • Errol H
    Errol H •
    it is in my view that researchers are playing with behaviors in the name of science that will not  be clearly understood unless the brain is comprehensively mapped.
  • Melissa Kennedy
    Melissa Kennedy •
    Thanks so much for the thought provoking comments. It's a huge issue, and I'd hate to simplify it here, but there are certainly some good things and many bad ones. While there is a great deal of pressure to treat those with mental health issues so that they don't end up doing the unthinkable, the side effect is that it can seem that there is a diagnosis for almost any sort of anxiety or discontent. I think that, as with anything, a medical professional is the only one who can really decide how severe the issue really is.
  • Holly W
    Holly W •
    I am seeing adults with Asperger's Disorder that are unable to maintain employment and in need of disability income to support themselves. They already have difficulties getting benefits.  What will happen to them under a general autistim spectre diagnosis?
  • Melissa M
    Melissa M •
    I certainly support the APA's  understanding for  making it easier to diagnose.   We live in a different day and age than when the DSM.lV was presented.   Just turn on your local news program as the unthinkable is being reported out and often time the person was not diagnosed with mental illness or was noncompliant with treatment.    The question is to what extreme is the person reacting whether  grief stricken, binge eating or frustrated.   Perhaps they will become homicidal or suicidal as we have often learned too late.    Personally, I have witnessed in my works as a licensed and certified SW (although currently unemployed) an increased number of individuals  "newcomers"  experiencing  acute psychiatric crisis that was  representative of not just the presenting problem,  but reflective of  a host of  psychosocial stressors( finances, housing issues, death, frustration with gov.,work or health problems etc) which altered  reactions and esculated the matter into a full blown psy crisis.  Most often requiring an  inpatient psy stay.We need to continue to build on our understanding of human behavior. What was considered normal 5 to 10years ago may not fit the definition of normal today.  I understand the concern of some critics wondering about excessive use of medications.  However,  we should credit this new DSM for acknowledging the need to be more inclusive in this day and time.   We as a society dont  know how to what extreme a  person  may react to life events.   But we do know, it going to take more than just a pill to  stabilizes the inidvidual.  The person benefits from therapeutic supports from a fully licensed SW, rest,nutrition, casemanagement supports.   Whether the  person is experiencing a psy crisis for the 1st time or 20th time im hopeful that a psychiatrist ( not PA or Nurse Practitioner) has all the tools he/she needs to fully  assess and determine the exent of  treatment.   
  • Madesa D
    Madesa D •
    If the D S M tool is not allowing for precise diagnosis, are psychologist going to add an addendum to their report findings or delete the using the  D S M for clients to obtain accurate Mental Health Services? What will become of the codes that are used nationally in medical fields?
  • Suzanne P
    Suzanne P •
    I disagree with a diagnosis code for grief.  Grief in my opinion as a therapist that has done many years of grief counseling is a natural process.  It is in my opinion that only when the grief becomes extended or people get stuck in one particular stage that a differential diagnosis is to be considered.  Regarding minor memory issues, again are we overstepping a natural process not seen as often because people are living longer lives and because life in general has become more complicated for everyone resulting in minor memory impairmene.  Labels stick and if a diagnosis code is to be used, awareness of the long term effects is of great importance.
  • Karen F
    Karen F •
    Too soon to tell- but some of this seems socio-political, and doing away with Asperger's seems to make no sense- if I understand it correctly...
  • Fresa H
    Fresa H •
    Hello, Everybody,The DSM involves ample fields that they do not identify as DSM. Someone shows in early stage symptoms of DSM. Next time, I will write about this.Thanks,Fresa
  • CRESCENTIA L
    CRESCENTIA L •
    Mental challenges are neurologically related and regardless of class
  • Robin F
    Robin F •
    Were social workers, who assess the individual in relation to the whole environment, involved in this revision? As a social worker with 30+ years working with an  adult and geriatric population, I take note around bereavement concerning death of any loved ones. This must be measured by the severity and longevity of symptoms to denote a clinical depression. This is a life changing event which needs to take its course in how the person adapts to this major change. Psychotropics have their place but supportive counselling is initially indicated to determine the depths of the breavement.Re: neruocognitve disorders with the older person and forgetfulness, one should look at the general life routine of the older person and whether he is solitary in his environment or has some stimulation which will allow for a more responsive reaction to others and events. A differential is always done concerning depression which will make the person inattentive to detail vs a dementia.
  • Kara F
    Kara F •
    Article is a useful descriptor of what has been called the "empiricization of psychiatry".Normality begins to fade away as a condition not in need of treatment. Is no one left normal?
  • Charles S
    Charles S •
    although there is a new DSM-5, psychiatrists should have the right to recall information from the  DSM-4 without any retribution, in order to service patients,and since science never dies, past diagnosis research should should not be all inclusive, which would allow previous patients to  continue receiving service for past diagnosis. The field of medicine is to treat the sick to say according to the Hippocratic Oath.
  • Daniel S
    Daniel S •
    There is so much research in psychopathy.  APD doesn't really get at it.  I wonder why they don't add it?

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