Mental Disorders: A Diagnostic Analysis

Implications

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been in existence for nearly sixty years, and began with the need to track statistical information of those classified as having a mental health disorder (Sartorius, et al., 1993). Since this time, the DSM has been revised multiple times in an attempt to have a commonality of mental disorders among differing clinicians around the world. This commonality has been met with a great deal of criticism and has been enveloped with controversy, particularly the current new release of the DSM V. For clinicians, the DSM is used as a diagnostic criterion tool that guides a diagnosis of mental disorder, and with each revision; a new learning curve must be advanced. However,

with change comes either acceptance or abandonment; in this case, with practitioners voicing their concerns over the newest revisions. The crux of the issue with the DSM V consists of the vast breadth this new model allows for diagnoses and the question of reliability and validity of the diagnostic criteria used to diagnose mental health disorders (Frances & Jones, 2014). Psychologists must consider the implications of these issues, in that the diagnosis of a mental illness must be made with critical attention and knowledge. The consequences of ignorance can be harmful to patients, clinicians, and the science of psychology.
According to the American Psychiatric Association (APA), practitioners have used the DSM since the inception of the first DSM, which was an adapted version of the World Health Organization (WHO) classification system called the International Classification of Diseases (ICD) (2015).

Throughout each revision, the DSM faced challenges by the professional community in reference to nomenclature, scientific developments, lack of specific definitions, inconsistencies, and finally, with the need for empirical foundations of criteria in the DSM IV (American Psychiatric Association, 2015). These issues lead to the twelve-year compilation of the DSM V in 2013. Before the release of this manual, the group in charge of the mechanics of the manual requested input from the professional community of practitioners from around the world, which lead to a great deal of peer experience and knowledge. However, the selection and choices determined by the group of what information was applied and not applied, has drastically changed the manual in multiple

areas.
These areas included what some clinicians considered indulgent diagnosis criteria. The claim was further propagated with the reasoning as being, to afford greater profit margins for pharmaceutical companies and those who represented the companies within the DSM V board (Obiols, 2012). According to an anonymous author, in the International Journal of Psychotherapy, “it also serves the pharmaceutical industry, perhaps rather more so than the mental health professionals, or their patients themselves” (2013). This sentiment was also echoed by clinicians that viewed the lack of transparency of the revision committee’s requirement of signing a confidentiality disclosure (Collier, 2010). The implication of this issue, in reference to clinicians, is the premise that this expansive increase in diagnostic terminology allows for most within the normal population to be diagnosed with a disorder (Frances, 2013) (Pearce, 2013). Therefore, the consequence will be more referrals to more practitioners, and more medications will be given, even to those who do not need to be medicated. This argument makes clinicians complicit in adding to the corporatization of science and leaves the patients at the precipice of being drugged for a nonexistent mental disorder. If psychologists are diagnosing mental disorders based on criteria that define an artificial construct, how will the practitioner know? The use of the DSM is the most commonly used reference for obtaining a diagnosis. If the criteria have been skewed toward more profit for pharmacological business, there is no reliability or validity in the diagnosis.
This issue lays bare the foundation of psychology with the question of the reliability and validity of the criterion within the manual.

Many have questioned the empirical basis for disorders such as gender dysphoria (Lev, 2013), Post-Traumatic Stress Disorder (PTSD) (Greenberg, Brooks, & Dunn, 2015), personality disorders (Skodol, 2011), learning disabilities (Scanlon, 2013), and many other disorders. The majority of the concern comes with the ambiguity of the methodology used in defining these disorders. The DSM V uses a blended dimensional and categorical approach. According to the American Psychiatric Association (APA), this approach was used in order to facilitate a cohesive diagnosis of individuals from mild to severe across differing clinical practices (2015). However, many practitioners argue combing a dimensional approach with a categorical approach has given way to a broad, unadulterated, overly generalized diagnosis of specific mental disorders. As Francis and Jones write in reference to using the DSM V criteria, “makes this worse by relabeling as mental disorder the sadness of grief, the temper tantrums of children, the normal forgetfulness of old age, the everyday distractibility of adult life, the worries of the medically ill, and the temptations of binge eating” (Frances & Jones, 2014). This opinion is reiterated with research, in regards to the empirical basis of categorization used in psychology for more than sixty years. Researchers have done little in the

way of testing the dimensional and categorical combinational approach to diagnosing mental illness (Widakowich et al., 2013). Thus, the categorical approach, that uses symptomology to assign disorders into discrete categories and has been vetted with decades of evidentiary findings, has been altered to a combined view that has not been thoroughly examined or validated. The significance of this development in clinical practice is apparent with a larger portion of the population being eligible to be diagnosed with a dimensional or level of a disorder. By using a categorical approach, clinicians can use specific symptoms, characteristics, and behaviors to determine a specific disorder. By using a dimensional approach, a clinician must quantify symptoms and rate them numerically to apply them to a diagnosis. To combine the two approaches, effectively diminishes the concrete basis of the categories and allows the encroachment of a broader range of behaviors to be included into a disorder.
The application of criterion from the DSM V should be evaluated empirically and must be placed into contextual critically processed diagnoses. Science is not absolute, it is evidence based construct that must be transparent and afforded the opportunity of being falsified. Clinicians must consider sources and the claims issued both for and against the DSM V. Psychologists must use evidence based approaches and determine, with caution, when to take a broad view of any construct to determine mental disorder. Practitioners know well the stigma, harm, and consequence of applying a diagnosis that is incorrect and the ramifications to the patients life. Psychology is a science that employs peer review, education, and empirical methods that solidify determinations as a method of furthering useful outcomes. There is no room for ignorant or uneducated blind followers in any sector of science, especially in psychology.