The Diagnostic and Statistical Manual of mental disorders (DSM) is used as the guideline for mental health intervention. Over time, the DSM diagnoses have provoked heated debate due to controversies in diagnoses criteria. The release of DSM V has further intensified these debates ranging from gender identity diagnoses to substance-related disorders and others. The DSM aims at providing a referential document that incorporates genetics, cognitive science, and neuroimaging to enhance precision in diagnosis and treatment of mental disorders. However, the changes in the revised DSM V have sparked debate on the disorders that deserve to be included in the physiatry guidebook. The APA argues that the changes in DSM V dont mark attention-calling departures from those in DSM IV (Paris, 2013). Although the controversial diagnosis is not a new concept in the DSM, critiques argue that those found in DSM V are worth reconsideration as they have the potential to expand the definition of mental illness drastically.
Examples of controversial diagnosis in DSM V
Introduction of a new disorder called Disruptive Mood Dysregulation Disorder (DMDD). It is a diagnosis for children between the ages of 6 to 18 who display anger outbursts that are considered to be out of proportion in intensity and duration. DMDD is a diagnosis meant to stem the misdiagnosis of child bipolar disorder as there is lack of sufficient, reliable scientific evidence to support bipolar. Also, the Aspergers syndrome was a stand-alone illness in DSM IV, but DSM V conceptualizes it in the autism spectrum disorder. (Gullo & OGorman, 2012) argues that most diagnoses in DSM V are forced with no clear distinction or evidence to support the differential diagnoses.
The concept of removing bereavement exclusion when diagnosing for depression also displays controversy in diagnosis. In DSM IV, the bereavement exclusion was used to exclude for people who meet criteria for depression, but the change has been as a result of bereavement. The exclusion in DSM V is argued to be, because sufficient evidence indicates that grief-related depression often morphs to normal grief. The controversy over the exclusion is the danger that this diagnosis might encourage doctors to medicate a natural emotional process. The APAs new classification provides for a consideration of depression two weeks after a person is bereaved (Vanheule, 2014). Critics argue that using this as a differential diagnosis is dangerous because it will lead to labeling of natural human behaviors as mental disorders, for this case, treating grief as clinical depression.
DSM V makes significant changes in diagnosis of personality disorders. Contradicting perspectives argue that the changes are not supported by sufficient empirical evidence ("Alternative DSM-5 Model for Personality Disorders," n.d.). The personality diagnoses criteria in the DSM are challenging to use and few, if any, clinicians use them. It calls for the need to adjust or simplify the diagnoses criteria.
The DSM is often referred to as the psychiatry bible. The phrase implies that this handbook must be reliable and referred to by all practitioners in the field of mental health in order to provide standardized treatment for patients. If the DSM V guidelines are controversial, it is challenging to define what standards of treatment professionals should adhere to. Having too many diagnoses is challenging for clinicians to conceptualize or diagnose while using the DSM, clinicians are obliged to consider the differential diagnosis (DeAngelis, n.d.). For instance, when a patient meets the criteria for diagnosing schizophrenia, it important to rule out the possibility of drug-induced schizophrenia. When diagnoses are too many with thin lines of differential criteria, it is challenging and highly likely that patients will receive a misdiagnosis. It is a commendable step that have filed a petition against the DSM V which has called for outside review of the DSM V to analyze its credibility.
Alternative DSM-5 Model for Personality Disorders. (n.d.). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. doi:10.1176/appi.books.9780890425596.156852
DeAngelis, T. (n.d.). Practice Directorate: Controversial diagnosis is voted into latest DSM. PsycEXTRA Dataset. doi:10.1037/e381742004-035
Gullo, M. J., & OGorman, J. G. (2012). DSM-5 Task Force Proposes Controversial Diagnosis for Dishonest Scientists. Perspectives on Psychological Science, 7(6), 689-689. doi:10.1177/1745691612460689
Paris, J. (2013). The Ideology Behind DSM-5. Making the DSM-5, 39-44. doi:10.1007/978-1-4614-6504-1_3
Vanheule, S. (2014). Context and Diagnosis in the DSM: The Issue of Validity. Diagnosis and the DSM, 53-87. doi:10.1057/9781137404688_2
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