The diagnostic and statistical manual of mental disorders is the standard classification of mental and health disorders that is used by professionals for diagnostic and research purposes. DSM, also known as the ‘mental health bible’, is what psychiatrists use to render an official diagnosis.
The draft for DSM V has been submitted and it will soon be published. Once it is published in May 2013, DSM-V will become the new textbook used for reference by mental health professionals. It is predicted to change everything from worker compensation claims to research and even prescribing medication for mental illnesses.
Advantages of the new manual that seem to be beneficial are the focus on dimensional assessment and careful consideration of gender, race and ethnicity. David Kupfer, M.D., chair of the DSM-5 Task Force explains his reasons for the suggested changes, “We know that anxiety is often associated with depression, for example, but the current DSM doesn’t have a good system for capturing symptoms that don’t fit neatly into a single diagnosis.”
But then a significant question lingers behind all the optimism: Will it dispel the confusion or create more of it?
With the recent changes in the upcoming DSM V the term “workplace sanity” is very likely to be redefined. Psychologists and psychiatrists all over the world fear that these controversial changes will lead to issues like “over-treatment” and “mislabelling”.
Even though the doctors can turn a deaf ear to the unnecessary changes, the courts will irrefutably have to obey them. This has been predicted by Doron Samuell, a psychiatrist who is an expert in workers’ compensation and insurance. This would further lead to a steep rise in the legal disputes and compensation cases. Insurance companies, psychologists, and the medical community depend on DSM daily to make decisions in the lives of clients. So the bigger the changes, the bigger will be the impact.
There are many essential concerns that sprouted as a result of the revised changes. Firstly, lowering the threshold for diagnosis may create a problem of irrelevant claims. It may give rise to an increase in non-clinical diagnosis and overmedication reducing the resources for those genuinely in need of them. Dr. Samuell states the example of an emergency worker who may put forward a claim of PTSD even after hearing details without being directly involved in an accident.
Another problem may show up when the new manual removes the distinction criteria between personality disorders and other conditions. So now, bullying claims even as a result of interpersonal conflicts will appear significant as a result.
A recent report from Safe Work Australia said, “Besides the burden work-related mental stress places on the health and welfare of employees, the impact on productivity of workplaces and the Australian economy is substantial”.
Even the architect of DSM-IV, Allen Frances has advised courts not to take up the new manual. He told Fairfax that when the criteria for diagnosing attention deficit hyperactivity was reduced by his team, it alone lead to an increase in its prevalence by 200%. There has been a tenfold increase in the autism diagnosis in the past 40 years and since the last DSM revision in 2000, it has increased 78%.
DSM-V’s content is already posing questions at society’s definition of what is considered “normal”. Critics have already labelled it as “hopelessly flawed”. Allen Frances states that, “Psychiatry is subject to fads” and “and very small changes can have huge unintended consequences”.
Let’s just hope that for sanity’s sake, these changes are for the best.
Australia Counselling recently spoke to Dr. Joel Paris about the new changes in the DSM-5. You can view that interview here.