On DSM-5

My recent blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right.

My three criticisms of DSM-5 have been: (1) risky suggestions; (2) bad writing; and (3) poor planning and disorganization.

My biggest concern regarding DSM-5 is that it will dramatically increase the rates of mental disorder by cheapening the currency of psychiatric diagnosis . . .The whole purpose of field-testing is to identify and correct problems in the preliminary DSM suggestions before they become set in stone as official guides to diagnostic practice.

Both the DSM-5 Web site and Psychiatry News have recently heralded the proposed DSM-5 revision for diagnosis of personality disorders.

Regretfully, if we are to judge the progress of DSM-5 by the incoherence of a recent commentary by the Chair and Vice-chair of the DSM-5 Task Force, we have a lot to worry about.

DSM-II was published in 1968. DSM-5 will be published in 2013. How much progress have we made? I propose that we approach this question with a quiz.

Writers of diagnostic criteria should consider their work and all its implications. What about adding a new disorder? What might that do to epidemiological capture? Depending on the characteristics of the diagnostic criteria set, many possibilities exist.

I’ve been deeply worried about corruption and greed in psychiatry for a long time. In reading the new book from Wendell Potter, formerly head of public relations at CIGNA, my worry has escalated into panic anxiety. Before discussing Potter’s work, let me review some of the widespread greed-related corruption of recent years.

The doctor’s role is to go beyond the obvious and to detect subtle determinants. Good diagnosticians have been trained to look beneath the loud symptom and consider underlying factors.