MSNBC just reported via Reuters on the flap over the DSM-5, the next edition of the Diagnostic and Statistical Manual of Mental Disorders that psychiatrists use to diagnose mental illnesses. “More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought,” says the article.
The article then talks about a number of proposed new mental illness diagnoses, some of which are, I agree, tough to swallow. For example, creating diagnoses for sex criminals “may allow offenders to escape prison by providing what could be seen as an excuse for their behavior,” says the article. Such diagnoses could indeed lead to legal nightmares, to be sure. And yet – you gotta admit some sexual predators certainly are sick.
There are two things, though, that bother me about the news report. The first is this statement:
… psychologists, psychiatrists and mental health experts said its new categories and “tick-box” diagnosis systems were at best “silly” and at worst “worrying and dangerous.”
I haven’t ventured into all the new categories and diagnoses, but in fact, the “tick-box” diagnosis system hasn’t changed from the current version, the DSM-IV. And I mean, there’s no difference. The DSM-5 lists the symptoms and the number of symptoms required for a diagnosis the same way the DSM-IV does.
The second is the focus on Oppositional Defiant Disorder. The article makes this sound like a new diagnosis when, in fact, it isn’t. Here’s the pertinent section:
Other examples of diagnoses cited by experts as problematic included … “oppositional defiant disorder” – a condition in which a child “actively refuses to comply with majority’s requests” and “performs deliberate actions to annoy others.”
“That basically means children who say ‘no’ to their parents more than a certain number of times,” [psychologist Dr. Peter] Kinderman said. “On that criteria, many of us would have to say our children are mentally ill.”
Oppositional Defiant Disorder appears in the DSM-IV, which has been around since 1994. The diagnostic criteria have been slightly revised in the DSM-5 proposal, and some portions are still under review, but by and large it remains the same. And both the DSM-IV and the proposed DSM-5 have versions of this critical item: “The disturbance in behavior causes clinically significant impairment in social, educational, or vocational activities.”
A child who says “no” frequently couldn’t be diagnosed with ODD under either the current or the proposed criteria.
I agree there are problems with the DSM-5. For example, the current proposal for the criteria for a hypomanic episode flatly contradicts itself. But it sure would help the public perception if news outlets would get their facts straight before publishing distortions like these.