DSM-V, a Prenatal Health Check

By Neuroskeptic | March 23, 2010 11:00 am

Last month the proposed draft of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) came out.

In my post at the time I was pretty critical of several aspects of the new DSM. Many many other blogs have discussed DSM-V, as have older media. As you’d expect with such a complex and controversial issue as psychiatric diagnosis, opinions have varied widely, but one thing stands out: people are debating this. Everyone’s got something to say about it, professionals and laypeople.

Debate is usually thought to be healthy, but I think in this case, it’s a very bad sign for DSM-V. The previous editions, like DSM-IV, were presented to the world as a big list of mental disorders carrying the authority of the American Psychiatric Association. That’s why people called the DSM the Bible of psychiatry – it was supposedly revealed truth as handed down by a consensus group of experts. If not infallible, it was at least something to take note of. There have always been critics of the DSM, but until recently, they were the underdogs, chipping away at an imposing edifice.

But DSM-V won’t be imposing. People are criticizing it before it’s been finalized, and even bystanders can see that there’s really no consensus on many important issues. The very fact that everyone’s discussing the proposed changes to the Manual is also telling: if the DSM is a Bible, why does it need to be revised so often?

My prediction is that when DSM-V does arrive (May 2013 is the current expected birth date) , it will be a non-event. By then the debates will have happened. I suspect that few researchers are going to end up deciding to invest their time, money and reputation in the new disorders added in DSM-V. Why study “temper regulation disorder with dysphoria” (TDDD) when it was controversial before it even officially existed? Despite the shiny new edition, we may be using DSM-IV for all intents and purposes for a long time to come.

CATEGORIZED UNDER: books, media, mental health
  • dearieme

    Is there an equivalent manual of physical disorders? Pox, small; elbow, tennis; leg, broken; heart, broken: oops, no, that last one is mental. But is it in there? I only ask because I knew someone who died of a broken heart. He chose the alcohol-assisted route.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Yes, there's the ICD, which also has a mental illness section.

    The current ICD-10 mental disorders are almost exactly the same as in DSM-IV, barring a few minor differences. my suspicion is that after DSM-V a lot of people are going to switch to using the ICD… it is already used in European psychiatry to some extent.

  • Anonymous

    This is what you get when you sit around a conference table and vote on whether a disease entity exists! Can you imagine oncologists voting on whether cancer exists? Can you imagine doing away with diabetes by a committee vote of physicians? Despite its efforts to rid itself of psychology, sociology, anthropology and philosophy, psychiatry cannot just wish away the complexity of human adaptation and substitute dumbed down neurobiological reductionism for critical and holistic thinking about people and their problems.

  • http://www.blogger.com/profile/10654138293659468787 NeuroPsych

    “Despite the shiny new edition, we may be using DSM-IV for all intents and purposes for a long time to come.”

    Heck, it's 2010 and I still read new research that uses DSM-III-R criteria.

  • http://www.blogger.com/profile/11302076828795198187 Cervantes

    The DSM, of whatever iteration, is enough to give me Intermittent Explosive Disorder. Not to mention Oppositional Defiant Disorder.

  • reasonsformoving

    So was it something about the process of how this new edition was formulated or is it something else – perhaps the state of the science that leads you to your conclusion?

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    reasonsformoving: Well I think the problems with DSM stem from a mix of both – the science just isn't there to support most of the new changes (and indeed many of the old disorders either) and yet the committee has decided to press ahead with them anyway, in many cases for clearly “strategic” reasons i.e. they've all but admitted that they're adding “TDDD” mainly to stop kids getting diagnosed with Bipolar Disorder.

    But my point in this post is that whatever the details of debates, the way they're happening out in the open (and that respected people like Spitzer are being openly critical) means that DSM-V is not going to be taken seriously when it arrives…

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Anonymous: Well with diabetes it's quite interesting. There are debates over what the exact definitions of diabetes, “metabolic syndrome”, impaired fasting glucose, impaired glucose tolerance etc should be and about the appropriate cut-offs e.g. what level of glucose in the blood is “too high”? Not everyone accepts the American Diabetes Association cutoffs…

    But in diabetes there is plenty of actual data e.g. search for “glucose cutoff” and you get hundreds of papers looking at different glucose levels and their correlations with heart disease, stroke, whatever in different ethnic groups.

    Whereas in, say, depression, there is almost no data looking at different cut-offs for “clinical depression” i.e. in DSM-V it's 5 symptoms from a list of 9, but would it be better as 4, or 6, or with different symptoms, or… we don't know.

  • http://historyclub.wordpress.com historyclub

    It is annoying how “strategic” the DSM is (is becoming?)—there were problems with the older versions, but the open admission that diagnoses are being added to help avoid misdiagnosing children (adding a new diagnosis instead of modifying the old one seems strange), waffling on whether to include Asperger's on the autism spectrum (it would help with getting therapy and educational assistance, but certain people don't like having a special diagnosis to themselves anymore), and including new diagnoses while stating that what we need is less pathology (as I heard a spokesperson say in an interview on NPR)…it all leads me to wonder whether the DSM is really trying to emulate science anymore.
    This is what worries me most—I've heard about allowing the public to “weigh in” on what to include and what to eliminate. Again, not that the older versions didn't have problems, but is asking for a public poll really the answer in fixing it?

  • http://www.blogger.com/profile/12858386284444095582 Austin

    I overwhelmed it. I have not adequate words in gratitude. Thanks for sharing with me. I will keep stay.
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  • Anonymous

    this is strange. my child who had a diagnosis of autism since age 3 and a strong family history of bi-polar(I,his mother) ,now at age 8 i was just told that he probably does not have autism (with a pddbi of 43), or bi-polar but instead has a temper regulation disorder. and they said he most likely has serious emotional disturbance? So the first thing i do is Google it and come across this site. Not reassuring . I am back to square one and no one can tell me what the differences are. perhaps i should take a poll.

  • Anonymous

    I also apologize as I don't have an extensive education, such as the others who post here . I'll admit this was the first article I came across when researching the current diagnosis for my son. I noticed there was no axis listed with this temper regulation disorder, and it does state high level of suspicion that's he does have pdd but not enough “collateral informants”?? 5 years 3 doctors not enough collateral informants? why all the changes now?

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    I'm sorry to hear about your son's difficulties… as you've probably realized there is a lot of uncertainty in this area.

    To be honest, my view is that by far the most important thing in these cases is individual competence, if you can find a good doctor or psychologist who has a good reputation and “seems right”, that's the most you can ask for. Because it is more art than science. But there are really good clinicians out there who get good results, you just need to make sure you find them.

  • Anonymous

    thankyou for your response. i agree with you on finding a good doctor. easier said then done. i do not agree with the emotional disturbed part as i think certain behavior can be explained away with the pdd. he also does not have the behavior problems ive seen others have with this disorder. im going to continue to advocate for my son and i know he will be fine. i have a large loving supportive family. for insurance reasons i needed a current diag. and thats what i got but for all practical reasons im sticking with the pdd .(chapel hill and etsu diag.) sometimes however i feel they(not all) want to change diag. so they can justify placing developing children on psychtropic medications… but thats another blog.

  • http://www.blogger.com/profile/08034913363346718433 sp00k00ps

    Okay. This is going to be…long! I finally get to announce this.

    “sometimes however i feel they(not all) want to change diag. so they can justify placing developing children on psychtropic medications…”-Well said! I even heard they are considering ADD as a “mental illness” in “need” of treatmet via ANTI-PSYCHOTIC DRUGS! Since when do they think ADD is a psychotic disorder? ADD does NOT have hallucinations or delusions! So would putting them on an anti-psychotic actually make things worse? Jusify. Perfect word to use! On developing children who need to, um…grow and exprience life without being drugged up to the point of loosing their sesne of what it means to be “normal”?? Sorry fols who are reading, I just have to type: F*ck that!

    It's obvious the people spewing this garbage out are desperate to put people (children even!) on drugs they 1. don't need 2. might have mild adverse reactions to or 4. might have severe adverse reactions to!

    The oppositional defiant disorder though is just rediculous! THE MOST FOUL STENCH MY EYES HAVE EVER HAD TO SCAN! Yes, when I read this the first time, I was crying and in a panic about for about two weeks! After that, I lost count! I would even start panicking if I just saw the LETTERS OPP, defy or disorder…okay, that's a word…never mind.

    After reading those scathing words by cervantes it penitrated my eyes, went to my brain and gave me a headache! I'm serious!

    The real thing I'm concerned with is how far will it go? How long will it be before even challening or even questioning authority is suddenly a metnal illness? WHat about Mozart? Einsein? Thomas Eddison? If they had been brought up under this new slate of “illnesses”, they may as well be given drugs, have their thoughts and inspirational ideas stripped away from them, barren into 'normality' and leaving us uncivilized, uncultured and spiraling into nothing but an waste land of uninspired dispair that has not seen the shimmering light of independent thought!

    Hehe, sorry, but this is just WAAAAAAAAAAAAAAAAAY too far for them to be pushing on people! Coming up with a bunch of “disorders' that only target personality flaws and quirks that make us all…unique? Ourselves? If anthing, maybe it's the poeple who are coming up with these “disorders” who need to be locked away and given a taste (or two…) of their own medicine?

    Sad…what is this world coming to, driven on drugs, picking profits and disorderly…disordered in disorders!

    I will SO have to agree with what Cervantes said: “The DSM, of whatever iteration, is enough to give me Intermittent Explosive Disorder. Not to mention Oppositional Defiant Disorder.”-Intermittent explosive disorder? WTF? That's just called ANGER, and the ODD crap…that ALREADY has a name, called REBELLIAN! WTF are theythinking?!? I think we can all agree that they are the real mentally deranged ones in the medical society!

    Wow, I must have really needed to get this off of my chest! I heard about this a YEAR ago and i've been just HOPING and dying (maybe lierally? Stress hormones pumping too high for too long can damage immune system function…) to know that some people are just as upset about this as I am! It actually does me some good to reaize that I'm not the only one who is outraged by this!

    Oh…now I must have…Psychosomatic Induced Heartache Disorder?!? Jees! MAKE THE MADNESS STOP!

  • http://www.blogger.com/profile/08034913363346718433 sp00k00ps

    WTF? Temper displacement disorder? There called temper tantrums and they are nornal for development, not some kind of “disorder” that needs treatment. Think if a child does not have the freedom to have a temper tantrum (medicated) then they might grow up not knowing how to deal with issues later in life, or it could do some other harm.

    Medicating children for normal behavior? Sesneless to me, utterly sesneless and it could be dangerous, very, very dangerous!

    Not to mention this also makes simple emotions ike anger, frustration and rational reasonable actions like rebellion sound like something that “needs” to be fixed, like there not supposed to be emotions or rational.

    So looks like according to whoever set this up had very little to no connection with reality when it comes to emotions!

    To add, it also sounds like they could be trying to get everyone on some kind of medication, as by the some of the narrow descriptions of these “disorders” ANYONE who gets jusifiably angry is now diseased and needs medical attention. To me, it sounds like they are trying to say EVERYONE has some kind of “severe” mental illness (and perhaps all kinds of them too!) and therfor needs to be medicated.

    To me this all seems utterly senseless and uncalled for! Pretty soon, everyone, even babies might be put on various medications they might not need in the first place!

    Anonnymous, I say don't let them give your child a diagnosis for something like that. Children will more than likely grow out of it, so why even medicate them if it's something they're more than likely going to outgrow anyway?

  • http://www.blogger.com/profile/08034913363346718433 sp00k00ps

    Oh I learned something today.

    It seems that a lot of children are diagnosed with ADD, but that could be more of a misdiagnosis (intentional or not). People with hypoglycemia can have ADD like behaviors, but we diagnose it as ADD.

    Makes me a bit skeptical as to how many people actually have ADD these das, especially looking at the candy and other junk food children so “love”…

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About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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