Why is there so much controversy surrounding the DSM-V?
October 28, 2013 3:52 PM Subscribe
Please point me to some resources (interviews, news articles, opinion pieces, etc...) so I can better understand why the DSM-V has generated so much controversy, and what the major points of contention are. The more gristly it is for my milling, the better.
Sam Kriss's book review treatment of the DSM-V -- "a new dystopian novel in the classic mode" -- might be a quirky place to start here, but there are lots of different ways in. Marcia Angell's broad narrative of the DSM's major revisions predates DSM-V, but provides context.
There's the question of whether disorders have been shaped to fit the catalogues of pharma companies, and of whether DSM-V assists in the normalisation of existing offlabel uses of drugs, and creates new opportunities for offlabel use. There's the ideological aspect, such as the merging of Asperger's under autism spectrum disorder.
There's the recoding of criteria that rejigs categories and "disorders" behaviour that was previously considered beneath diagnostic thresholds. There's the question of whether revising the DSM has become the APA's cash-cow. There's a re-ignition of the psychiatry/psychology turf wars, given that so many disorders are now associated with pharmaceutical treatments.
There's also the professional burden, in that mental health professionals now have to buy a $120 book, a $60 pocket reference guide, and however much it costs for the many retraining and "what's new" continuing education sessions that are running in every decent-sized city right now.
The US government uses ICD codings for HIPAA compliance in billing, and while DSM-V is considered "complementary" to and compatible with ICD-10, there's a very different prevailing narrative in the Green Book.
posted by holgate at 4:29 PM on October 28, 2013 [5 favorites]
There's the question of whether disorders have been shaped to fit the catalogues of pharma companies, and of whether DSM-V assists in the normalisation of existing offlabel uses of drugs, and creates new opportunities for offlabel use. There's the ideological aspect, such as the merging of Asperger's under autism spectrum disorder.
There's the recoding of criteria that rejigs categories and "disorders" behaviour that was previously considered beneath diagnostic thresholds. There's the question of whether revising the DSM has become the APA's cash-cow. There's a re-ignition of the psychiatry/psychology turf wars, given that so many disorders are now associated with pharmaceutical treatments.
There's also the professional burden, in that mental health professionals now have to buy a $120 book, a $60 pocket reference guide, and however much it costs for the many retraining and "what's new" continuing education sessions that are running in every decent-sized city right now.
The US government uses ICD codings for HIPAA compliance in billing, and while DSM-V is considered "complementary" to and compatible with ICD-10, there's a very different prevailing narrative in the Green Book.
posted by holgate at 4:29 PM on October 28, 2013 [5 favorites]
I think one of the big issues is that it endorses diagnosing children with bipolar disorder
posted by thelonius at 5:45 PM on October 28, 2013
posted by thelonius at 5:45 PM on October 28, 2013
All DSM updates create lots of controversy, mainly because we're in such an infancy stage in psychiatry and psychiatric treatment. Make sure you contextualize whatever you're reading in light of all the past controversies about the DSM.
posted by jaguar at 8:02 PM on October 28, 2013
posted by jaguar at 8:02 PM on October 28, 2013
I read a really good overview recently in the London Review of Books, titled "Lost in the Forest: Who Needs the DSM".
Quote from the intro: "...Hence its publication has been greeted by a flurry of discussion, hype and hostility across all media, both traditional and social. Most of it has concerned individual diagnoses and the ways they have changed, or haven’t. To invoke the cliché for the first time in my life, most critics attended to the trees (the kinds of disorder recognised in the manual), but few thought about the wood. I want to talk about the object as a whole – about the wood – and will seldom mention particular diagnoses, except when I need an example..."
If you can't access the entire article (it varies) email me and i'll send you a copy.
posted by kev23f at 4:26 AM on October 29, 2013
Quote from the intro: "...Hence its publication has been greeted by a flurry of discussion, hype and hostility across all media, both traditional and social. Most of it has concerned individual diagnoses and the ways they have changed, or haven’t. To invoke the cliché for the first time in my life, most critics attended to the trees (the kinds of disorder recognised in the manual), but few thought about the wood. I want to talk about the object as a whole – about the wood – and will seldom mention particular diagnoses, except when I need an example..."
If you can't access the entire article (it varies) email me and i'll send you a copy.
posted by kev23f at 4:26 AM on October 29, 2013
Response by poster: Thanks all! This has given me a good starting point.
I've been reading about the various criticisms, and one that really stuck in my craw is the issue of DSM-V's field trials.
As it turns out, DSM-V reformulations of disorders like Generalized Anxiety Disorder and Major Depressive Disorder were much less reliable than in previous editions (i.e., DSM-III and DSM-IV). Overall, diagnoses were found to be acceptable for only 5 out of the 23 disorders tested. Staggering!
posted by tybeet at 7:09 AM on October 29, 2013
I've been reading about the various criticisms, and one that really stuck in my craw is the issue of DSM-V's field trials.
As part of the DSM-5 field trials, 2246 patients with various diagnoses and degrees of comorbidity were interviewed (86% twice) on the basis of the DSM-5 criteria. Interviews were conducted by 279 clinicians in various disciplines who received training similar to what would be available to clinicians after publication of the DSM-5.Basically, the field trials were to assess if diagnoses would be consistent from one clinician to the next.
As it turns out, DSM-V reformulations of disorders like Generalized Anxiety Disorder and Major Depressive Disorder were much less reliable than in previous editions (i.e., DSM-III and DSM-IV). Overall, diagnoses were found to be acceptable for only 5 out of the 23 disorders tested. Staggering!
posted by tybeet at 7:09 AM on October 29, 2013
In the latest Brain Science Podcast Ginger Campbell interviews Allen Francis, the author of "Saving Normal..." about DSM-V.
posted by apolune at 11:18 AM on October 29, 2013
posted by apolune at 11:18 AM on October 29, 2013
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posted by jessamyn at 4:03 PM on October 28, 2013 [5 favorites]