DSM 5

DSM5

Greg Crowhurst 20th July 2011



..Here’s what they are saying about DSM 5 - which appears to be based on not much more than personal opinion.

The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective
judgements, with little confirmatory physical 'signs' or evidence of biological causation.  The criteria are not value-free, but rather reflect current normative social expectations.  Many researchers have pointed out that psychiatric diagnoses are plagued by problems of reliability, validity, prognostic value, and co-morbidity.

Response to the American Psychiatric Association: 
DSM-5 Development .The British Psychological Society thanks the American Psychiatric Association (APA) for the
opportunity to respond to the DSM-5 Development.  
http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf

 
The DSM-III was almost certainly more “reliable” than the earlier versions, but reliability is not the same thing as validity. Reliability, as I have noted, is used to mean consistency; validity refers to correctness or soundness. If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be “reliable,” but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers.

Marcia Angell The Illusions of Psychiatry

New York Review of Books JULY 14, 2011
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/




Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies.

Marcia Angell The Illusions of Psychiatry

New York Review of Books JULY 14, 2011
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/



As psychiatry became a drug-intensive specialty, the pharmaceutical industry was quick to see the advantages of forming an alliance with the psychiatric profession. Drug companies began to lavish attention and largesse on psychiatrists, both individually and collectively, directly and indirectly. They showered gifts and free samples on practicing psychiatrists, hired them as consultants and speakers, bought them meals, helped pay for them to attend conferences, and supplied them with “educational” materials.

Marcia Angell The Illusions of Psychiatry

New York Review of Books JULY 14, 2011
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/



About a fifth of APA funding now comes from drug companies.
Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.

Marcia Angell The Illusions of Psychiatry

New York Review of Books JULY 14, 2011
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/





In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.

Marcia Angell The Illusions of Psychiatry

New York Review of Books JULY 14, 2011
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/



Allen Frances, chairman of the DSM-IV task force, is highly critical of the expansion of diagnoses in the DSM-V. In the June 26, 2009, issue of Psychiatric Times, he wrote that the DSM-V will be a “bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.”

Marcia Angell The Illusions of Psychiatry

New York Review of Books JULY 14, 2011
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/


There still isn’t a diagnosis listed in the major psychiatric diagnostic
manuals (such as ICD and DSM) that is associated with any sort of physical test and so, unlike the rest of medicine, aetiology has an insignificant part to play in organising diagnostic practice. Whilst reliability in making diagnoses has improved for some research purposes, this does not necessarily translate to clinical practice andthe more important issue of validity remains poorly addressed. Most importantly there is no evidence to show that using psychiatric diagnostic categories as a guide for treatment leads, through evidence based choices, to improved outcomes.

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf


The failure of basic science research to reveal any specific biological abnormality or for that matter any physiological or psychological marker that identifies a psychiatric diagnosis is well recognised. Unlike the rest of medicine, which has developed
diagnostic systems that build on an aetiological framework, psychiatric diagnostic manuals such as DSM-IV and ICD-10 have failed to connect diagnostic categories with any aetiological processes.

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf



Despite years of searching for biological correlates, the failure of basic science research to reveal any specific biological marker for any psychiatric diagnostic category reveals that
current psychiatric diagnostic systems do not share the same scientific security of belonging to the biological sciences as the rest of medicine.

Unlike in the rest of medicine where the reason for the patient’s symptoms is clarified by a diagnosis, psychiatric diagnoses serve empirically as nothing much more than descriptors. Thus,
when a clinician claims that a patient is „really. depressed, or has ADHD, or has bipolar disorder, or whatever, not only are they trying to turn something based on subjective opinion into something that appears empirical, but they are engaging with the process of reification (turning something subjective into something concrete.).

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf



… there is a large literature on psychotherapy confirming that it is generally speaking a safe and effective intervention for common mental health problems as studied in Western populations, but there is little to suggest that a positive outcome is
strongly related to selecting the correct psychotherapeutic technique and much to suggest that the common factors such as developing a strong therapeutic alliance, are more important. For example, several studies have shown that most of the specific features of Cognitive Behaviour Therapy (CBT) can be dispensed with, without adversely affecting outcomes.

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf




..having a good relationship with the prescribing doctor is a stronger
predictor of a positive response to an anti-depressant. than just taking the drug regardless of who prescribes it.

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf





in the UK the Royal College of Psychiatrists and Royal
College of General Practitioners launched their „Defeat Depression. campaign in the early nineties. It was intended to raise public awareness of depression, reduce stigma, train general practitioners in recognition and treatment, and make specialist
advice and support more readily available. Unfortunately, evaluations of treatment and education guidelines in the UK following the  Defeat Depression. campaign
failed to detect significant improvements in clinical outcome. However, other effects of the campaign included a rapid increase in antidepressant prescribing and increased medicalisation of unhappiness and distress.

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf



For any diagnostic system to establish itself as a scientifically useful paradigm that leads to greater knowledge of the natural world, it should be able to show that the categories „carve nature at its joints. such as being able to demonstrate distinct
aetiological links. For any diagnostic system to establish itself as clinically useful it must show that use of diagnostic labels aids treatment decisions in a way that impacts on outcome..…. there is little evidence to support the ICD/DSM paradigm being able to provide either the basis for collecting scientifically useful knowledge or clinically useful treatment decisions. There is much evidence to suggest that instead they can cause significant harm. The only evidence based conclusion that can be drawn is therefore that formal psychiatric diagnostic systems like ICD and
DSM should be abolished.

Sami Timimi

March 2011
Campaign to Abolish Psychiatric diagnostic Systems such as ICD and DSM
(CAPSID)1,2
http://www.criticalpsychiatry.net/wp-content/uploads/2011/05/CAPSID11.pdf




The DSM-V will officially sanction suffering
and dysfunction like never before, with new disor-
ders such as “Post Traumatic Embitterment Disor-
der,” “Compulsive Shopping,” and “Internet
Addiction Disorder,” all being considered for addi-
tion to the official list of psychiatric disturbances.
The folks writing the new DSM-V are even consider-
ing a new classification of “prodromal” disorders,
which means you may qualify for diagnosis of a
mental disorder just based on the hunch of your
psychiatrist.

Prognosis Negative
Psychiatry and the Foibles of the Diagnostic and
Statistical Manual V (DSM-V)
BY JOHN SORBORO, M.D.
SKEPTIC MAGAZINE volume 15 number 3 2010
http://www.psychiatry.freeuk.com/SorboroDSM.pdf




Description is not the same thing
as explanation, and the DSM explains nothing. For
example, does labeling someone with “major de-
pression” really tell you anything more than just
saying they are “very depressed”? Can major de-
pression be objectively separated from the suffering
of other depression such as grief, in a meaningful
way? No, it can’t, at least not objectively. But such a
diagnosis in the world of mental health is important
because it is a loaded value-laden term implying
that we know something objective about the per-
son’s emotional state. (Like Parkinson’s disease al-
lows us to know something about a patient’s
neurological state.) It confers medical legitimacy on
the description, suggesting that it is a distinct dis-
ease state separate and more severe. It also makes
the condition no longer dependent on the events
that may have caused it. We can objectively know
nothing of the sort because the diagnosis is based
on arbitrary symptom lists that are non-specific and
almost always gleaned from self-report and pure
speculation. We have no way of objectively validat-
ing anything. This is akin to saying a person has a
diagnosis of a “major pain.”

Prognosis Negative
Psychiatry and the Foibles of the Diagnostic and
Statistical Manual V (DSM-V)
BY JOHN SORBORO, M.D.
SKEPTIC MAGAZINE volume 15 number 3 2010
http://www.psychiatry.freeuk.com/SorboroDSM.pdf



We know hardly anything more of real scien-
tific significance about bipolar disorder than we did
in 1980, but we sure have gotten good at diagnosing
and medicating it along with lots of other things.
There has been explosive growth in the diagnosis of
mental illness and use of atypical antipsychotics
and antidepressants, the two fastest growing cate-
gories of psychotropics, which are both used to
treat almost every conceivable major psychiatric
disorder, including bipolar disorder.

Prognosis Negative
Psychiatry and the Foibles of the Diagnostic and
Statistical Manual V (DSM-V)
BY JOHN SORBORO, M.D.
SKEPTIC MAGAZINE volume 15 number 3 2010
http://www.psychiatry.freeuk.com/SorboroDSM.pdf






An apparently scientific argument is said to be “not
even wrong” if it is based on assumptions that can-
not possibly be falsified or used to predict any-
thing. I am afraid after nearly 20 years in the belly
of the beast of psychiatry I come to no other logical
conclusion than that for the most part the DSM and
the psychiatry behind it are “not even wrong.” The
entire premise of artificially and endlessly cata-
loging every conceivable form of human suffering
or perceived dysfunction is neither helpful nor
sound. It is a confused attempt to apply the princi-
ples of the hard sciences like physics and chemistry
to the softest of social sciences. The DSM takes
great pains to be a-theoretical because it knows it
must. The DSM jettisoned the flawed Freudian the-
ory that held it together after the 2nd edition, but
today it is just a big catalogue of symptom lists.

Prognosis Negative
Psychiatry and the Foibles of the Diagnostic and
Statistical Manual V (DSM-V)
BY JOHN SORBORO, M.D.
SKEPTIC MAGAZINE volume 15 number 3 2010
http://www.psychiatry.freeuk.com/SorboroDSM.pdf

the DSM5 leadership created a fortress mentality that has so far prevented the identification and correction of bad ideas. Work group members were compelled to sign muzzling confidentiality agreements. Advisors were few and seemed to be selected to limit the possibility of critical review. Most damaging, the field has (except for the inevitable leak and the occasional presentation) been largely left in the dark about methods, timelines, and emerging suggestions.

How Psychologists Can Help Correct DSM5
A review of Problems in DSM 5.
Published on March 6, 2010 by Allen J. Frances, M.D. in DSM5 in Distress
http://www.psychologytoday.com/blog/more-diagnosis/201003/how-psychologists-can-help-correct-dsm5

What little we know about the DSM5 methods encourages no confidence. Apparently, there has been little consideration of what should be the criteria for change, how to conduct risk/benefit analyses, how empirical documentation should be organized, how to write clear and consistent criteria, and when and how to conduct field trials. Left to their own devices and without external quality control, the DSM5 drafts are filled with suggestions that will have extremely damaging consequences. Finally, there is no one working on DSM5 who has experience writing diagnostic criteria- not surprisingly the new criteria sets are amateurish and require extensive revision.

How Psychologists Can Help Correct DSM5
A review of Problems in DSM 5.
Published on March 6, 2010 by Allen J. Frances, M.D. in DSM5 in Distress
http://www.psychologytoday.com/blog/more-diagnosis/201003/how-psychologists-can-help-correct-dsm5

What are likely to be the worst suggestions in the draft DSM5?
Impact on clinical practice-the DSM5 drafts contain many proposed new diagnoses that will be very common in the general population - i.e. binge eating
, mixed anxiety depression, minor cognitive disorder, pre-psychotic risk syndrome, etc. The rationale for including these is that early identification and treatment will reduce severity, impairment, complications, and the risk of treatment resistance. Indeed, the diagnosis of sub-threshold conditions would of course be highly desirable if we had methods of early identification that were sufficiently sensitive and specific-but we simply do not. These suggestions (along with the drug company marketing that would undoubtedly accompany them) could create tens of millions of misidentified false positive "patients" who would then be subjected to unnecessary, expensive, and often quite harmful medication treatments.

How Psychologists Can Help Correct DSM5
A review of Problems in DSM 5.
Published on March 6, 2010 by Allen J. Frances, M.D. in DSM5 in Distress
http://www.psychologytoday.com/blog/more-diagnosis/201003/how-psychologists-can-help-correct-dsm5


Aside from its reckless proposals for dangerous new diagnoses, the most characteristic thing about DSM-5 has been its remarkably poor planning and its consistently missed deadlines. By ambitiously over-promising and then inefficiently under-delivering, DSM-5 finds itself forever falling far behind its own scheduling targets, which then must constantly be pushed further and further into the future.  But the future is now closing in on DSM-5. Its propensity for procrastination has already compromised the diagnostic coding system and suggests that the DSM-5 endgame will not be pretty.

The Constant DSM-5 Missed Deadlines And Their Consequences: the Future is Closing In
By Allen Frances, MD | April 15, 2011
http://www.psychiatrictimes.com/dsm-5/content/article/10168/1844722

The planning committee in charge of writing the DSM-5, the replacement to the DSM-IV, wants to scrap this category (undifferentiated somatoform disorder ) and create a new one called simply “Somatic Symptom Disorders.”  What makes a “Somatic Symptom Disorder” in the new classification?  According to the APA, “any somatic symptom or concern that is associated with significant distress or dysfunction,” combined with “anxiety” or “persistent concerns” about the symptoms.  Have a nasty, persistent cough?  Frequent headaches?  Concerned about it?  Congratulations, you may now have a mental illness as well.  They also propose a “complex somatic symptom disorder” (CSSD) category in which the symptom(s) is/are accompanied by “excessive or maladaptive response” to those symptoms.  What’s excessive or maladaptive?  As with anything in psychiatry, that’s for you (or, more accurately, your doctor) to decide.

Psychosomatic illness and the DSM-5

http://thoughtbroadcast.com/2011/01/21/psychosomatic-illness-and-the-dsm-5/

It’s one thing to be so devastatingly ill that the simplest of personal activity is reduced to a crawl.
It’s wholly another when through misdiagnosis and ridicule, you’re branded as a misfit, lazy, a malingerer, and one who’s told “it’s all in your head”. When this happens, an already hideous and debilitating illness is exacerbated and our population is doomed to decades of disease.

I’ve seen it, I’ve experienced it, it’s a common denominator, and it has to stop.

Currently, the American Psychiatric Association seeks to reclassify Chronic Fatigue Syndrome as a somatoform disorder [(denoting physical symptoms that cannot be attributed to organic disease and appear to be psychogenic (having an emotional or psychologic origin.)] in their fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled to be published in 2013.

If this happens, we will be plunged back into the dark ages of medicine and countless thousands of American’s will suffer the disgrace and humiliation caused by this dreadful misrepresentation.

Rik Carlson
http://www.vtcfids.org/dsm5.html

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