The Diagnostic and Statistical Manual (DSM) of mental disorders is a widely used and popular text that lists and describes the various mental disorders and the criteria that resembles each one specifically. These series of manuals have had several major problems since their introduction and the latest edition which has yet to release still faces problems in terms of validity with the scientific community. By use of a diagnostic criterion they fail to incorporate many factors such as social influences, a scientific base, and distinction between the criteria for the different disorders. These are only a few of the problems facing the DSM but they may also be the most significant. The largest problem with the diagnostic model of the DSM I believe is the complete neglect of social context in relation to behavior. The DSM provides criteria for which clinicians and psychiatrists can make diagnoses but fails to incorporate how a social factor, like the loss of a family member, can lead to behaviors characteristic of a mental disorder such as General Anxiety Disorder. This can lead to many instances of misdiagnosis in either a false negative or false positive manner. There could also be misinterpretation due to social differences where something that is natural to someone in one culture is seen as problematic to another in a different culture. The largest problem that arises from this lack of recognition for social factors is the fundamental attribution bias, which is the misinterpretation of a behavior as due to a person’s personality rather than a result of environmental forces. If people do not have the time or energy to consider these implications that society has on behavior, many misdiagnoses and misinterpretations will continue ... ... middle of paper ... ...making a positive contribution. With more criteria, there should be a stricter process of diagnosing people and better accuracy in doing so. This is not the case as repetitive criteria increase the supposed prevalence rate of different disorders and work to create confusion throughout the scientific community. These problems will continue to hinder the validity of the DSM and with the popularity of these manuals, there may also continue to be negative influences such over-diagnoses. There will also be continued influence from both the government and the pharmaceutical companies that can sway the production of the manuals which may not be in the best interest of science. The authors explain it best I believe when they describe the DSM as a fictitious guide searching to solve every human problem. There may well not be a solution to all the problems that people face.
A physician has an unenviable position; he is closest to man approaching a god-like stature. And despite the demise of 'doctor knows best', we still need to trust his diagnosis-something that is increasingly difficult in a world where information is widely available, and Google substitutes for a doctor. In the case of psychiatry the issue of trust is amplified since diagnosis is based on a patient's expressed thoughts and overt behaviours rather than solely on biological phenomena. And these thoughts and behaviours are influenced by the patient's environment-a mix of his social, cultural and technological experiences.
...s that the DSM can also falsely determine ones specific mental health, showing the struggle between diagnosing someone with genuine disorders and excessively diagnosing individuals.
Association, A. P. (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Frances, A., & Ross, R. (1996). DSM-IV case studies a clinical guide to differential diagnosis. Washington, DC: American Psychiatric Press, Inc.
Allen Frances spends his time concluding his thoughts about the DSM and diagnostic inflation in the third part of “Saving Normal”. Frances appears to be passionate about reducing over-diagnosing and unnecessary medication. Frances did a good job providing us with ways that can change the future of diagnosis. Having a complete culture change will be difficult, but we can begin by educating ourselves.
Identification of any psychosocial or contextual factors to be considered, as outlined in the DSM-5
... just the illness as a whole. There are also issues with how broad the spectrum of mental illness is. With each new idea in mental health some hope is given that someone will find treatment.
The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization, 1992. Print.
`In the past, I worked in such a research setting, where if a person was found to meet criteria for opiate dependence they received treatment, however if even slightly short of DSM-IV criteria for the disorder they would have to look elsewhere. This was a continual concern for me, as the person who met criteria was not always the person with the most distress, and alternative treatments were not easy for people to find. Largely from this experience, I find the current categorical approach to classifying persons with psychopathology to be an imperfect system at best, with the primary advantage of being convenience when communicating with other professionals. I question whether this convenience comes at a severe cost to accuracy, the result of which is an artificial limit to the range of presentations that occur in psychopathology. As the example above illustrates, the particular aspect that I find most problematic is the use of cutoffs for specific symptoms, for instance the length symptoms must have been present for it to be classified as a disorder, or even the number of symptoms that need to be present. I think it is unlikely that a person who “almost” meets criteria for a disorder would be significantly different from a person with similar symptoms who just barely meets criteria. In private practice these two cases would likely be treated similarly, but in a setting where diagnosis serves as a screening tool the client who met criteria may get treatment while the other does not. In this case I feel that less specific guidelines, lacking specific numerical limits would alleviate many of the problems.
The disorder which is being treated is actually strengthened to the point of a serious mental illness. Similarly, in today’s society, medical and psychological advice may have the same effect. Medical technology and practice have progressed considerably since the time of the “Yellow Wallpaper.” This is not to say that today’s physicians are infallible. Perhaps some of today’s treatments are the “Yellow Wallpaper” of the future.
Psychological disorders could be better defined. It is described as mental or behavior pattern that cause a person suffering and is not seen as socially acceptable of normal. The field is growing each year and they are developing a better understanding of how to diagnose and treat the disease. After reading about the DSM-IV-TR it does seem like a more efficient resource for strictly psychological diseases does need to be produced especially, because the amount of psychological disorders has grown so much in the past 60 years and will continue to grow. The medical model states that an "illness" must have a physical cause that can be diagnosed, treated, and in most cases cured. I do believe that this may be true for some psychological disorders, but not all of them can fit into this model. The biopsychosocial approach picks up where the medical model leaves off. It is very apparent that some psychological disorders can be influenced by a person's environment, their social skills, and their culture. In Latin America you may never see anorexia or bulimia, but they have their own disorder...
Caplan, P. (2012), Psychiatry’s bible, the DSM, is doing more harm than good, The Washington Post, 27 April.
Saving Normal by Allen Frances is an exploration of the major diagnostic inflation currently occurring in the field of psychiatry. Frances, a prominent and accomplished psychiatrist, is best known for being chair on the task force in the production of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), often considered the “bible of psychiatry”. Being an insider, Frances has extensive knowledge of the causes of diagnostic inflation and exactly how the psychiatry field has faced difficulties. In Saving Normal, Frances delves into the history of diagnosis, presents the negative effects of its increase, and considers solutions to this rapid rise. Asserting that the the increase in diagnosis is out of control,
I think the video featuring Dr. Frances highlights some of the controversy surrounding the publishing of DSM-5. It was interesting to see how changes regarding diagnoses of mental disorders in the DSM-5 could have such overarching effects. Dr. Frances mentioned the specific example of the change regarding a possible diagnosis of major depressive disorder after just two weeks of symptoms, even in times of grief/mourning. In his opinion this was overreach and people experiencing normal grief could be classified with a disorder. According to Regier,Kuhl, & Kupfer (2013) the original two month guideline in DSM-4 was not thought to be specific enough. “Unfortunately, this [two week guideline] also prevented bereaved individuals who were experiencing
Mental illness is the condition that significantly impede with an individual’s emotional, cognitive or social abilities (Savy and Sawyer, 2009). According to (Savy and Sawyer, 2009) neurological, metabolic, genetic and psychological causes are contributing factors for various types of mental illness like depression, schizophrenia, substance abuse and progression of condition. An elaborate system known as DSM-IV-TR gives a classification system that acts to separate mental illness into diagnostic categories based on the description of symptoms of illness (Savy and Sawyer, 2009). The exact primarily causes of mental illness are complicated, however, it seems to occur in a psychologically and biologically prone individual, in the trigger of environmental and social stress (Elder, Evans and Nizette, 2007).