Saturday, June 22, 2013

Why does the APA need new editions of DSM?

Simon Wessely in his blog post about an IOP conference on DSM-5 assumes there will be a DSM-6. Have we now come to expect continuous revision of psychiatric classification? If so, it's difficult to understand why. There has never really been any expansion of "the scientific basis for psychiatric diagnosis and classification" despite this being the apparent impetus for DSM-5 (see website). Maybe APA's motivation for continuous revision is merely financial gain. DSM-IV made at least $100 million, but, even so, DSM-5 should be free open access to all on the internet.

The reason for the DSM-III revision was very clear (eg. see my article). From mainstream psychiatry's point of view, diagnosis was in crisis because of its unreliability. Operational criteria were therefore developed. Unfortunately these may be no more valid than commonsense definitions. So, we could put up with amendments through DSM-III-R, DSM-IV and DSM-IV-TR, but tinkering further with DSM-5 is a step too far.

As Simon says, "The aspiration that DSM-5 would represent as significant a break with the past as DSM-III had been, effecting a second revolution by moving from symptom based diagnosis to aetiologically based diagnosis using the latest advances from neurosciences and genetics turned out to be just that, an aspiration". That's why the current NIMH director has turned his back on DSM-5 (see previous post), although his predecessor was one of the originators of the DSM-5 process in 1999. However, despite all the DSM revisions, there's no getting away from the poor validity and reliability of psychiatric diagnosis. That's its nature and psychiatry's wishful failed ambition needs to be recognised for what it is.

1 comment:

susanne said...

So what happens to people who have been wrongly labelled? Will these be deleted from their records - together with all the other insulting 'diagnoses'. Even psychotherapists have joined in now with a classification which apes the discredited psychiatric formuala. It's a roller coaster which has become almost impossible to stop now there's more fun to be had using neuropsychiatry's unproven 'diagnoses'. Once they are hung around a real human being's neck they cause so much additional harm - on top of the adverse effects of prescription drugs often prescribed without informed consent or proper monitoring. Psychiatry is a mess whichever way you look at it.