You may have already heard our big news in psychiatry: The first major revision of the Diagnostic and Statistical Manual (DSM) since the mid-1990s has just been approved by American Psychiatric Association's Board of Trustees. And the new DSM-5 will be published in May.
Trans persons are no longer classified by the medical community as mentally ill, this decision coming 39 years after homosexuality was declassified as a mental illness. I have been involved in many civil rights campaigns, but as a physician, none has mattered more to me than this one.
My best advice to clinicians, to the press, and to the general public -- be skeptical and don't follow DSM-5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the 10 changes that make no sense.
The DSM-5 autism group has been blinded by an intellectual conflict of interest. Eager to introduce its concept of an autism spectrum, the group lost sight of a crucial and obvious fact: Its proposed criteria set is written so exclusively that it must inevitably reduce the diagnosis of autism.
Two years ago, the American Psychiatric Association announced the start of field trials of proposed diagnostic criteria for the future DSM-5. And now, as the first comprehensive analyses of that effort are published, what's clear is just how well the field trials did their job.
Virtually anything can be addictive for the "right" person at the "right" time -- one of stress or disorientation, when that experience holds out significant and powerful associations for the person, when the person is not inclined or able to be restrained.
There is no doubt that most of us have become hooked on our electronic devices, and that some people are gravely harmed by what develops into an unhealthy and uncontrollable attachment to them. The question is how best to understand, define, and deal with this.
On the eve of the release of A Dark Knight Rises, I'm going to consider whether Batman has posttraumatic stress disorder (PTSD), the psychiatric disorder that most people may think a likely diagnosis for Batman.
The petition to reform DSM 5 speaks with the powerful voice of more than 50 mental-health associations. It represents a significant percentage of the potential customers who eventually will have to decide whether or not DSM 5 is worth buying and using.
The APA offers a fait accompli that DSM-5 will be published in 2013 despite the poor Field Trial results, the petition requesting independent review from fifty-one mental health professional associations, the opposition from The Lancet and New England Journal of Medicine.
DSM-5 is in such public trouble now because it heedlessly missed every prior private opportunity to self-correct. The solution is not the production of more PR pablum. Instead, DSM-5 needs to regroup, solve its problems, and avoid racing over a cliff.
In a recent piece on The Huffington Post, Allen Frances, M.D., demonstrates either an embarrassing lack of knowledge and understanding of financial reporting or an intentional misrepresentation of facts in his continuing effort to attack the forthcoming DSM-5.
Psychiatric diagnosis has become too important to be left in the hands of a small, withering, cash-strapped, incompetent association that feels compelled to regard its bottom line as a higher priority than having a safe, scientifically sound, and widely accepted diagnostic system.
If a legendary figure like Bob Spitzer can correct his mistakes, surely the American Psychiatric Association can do the same -- for the sake of protecting our patients and keeping the mental health field united.
The new DSM will not cause more people to be diagnosed with addiction. Instead, more people who may not yet be addicted (but whose substance use is nonetheless unhealthy) will be able to access very inexpensive but proven effective treatment earlier and more easily.
There is an inescapable conceptual struggle when dealing with America's volatile history of, and attitudes toward, substance use. In other words, the meaning of addiction is a never-ending American, and thus worldwide, cultural debate.
Unfortunately, DSM 5 will make the current problems with mislabeling much worse. Its new proposals (with the possible exception of autism) all cast a wider diagnostic net that will lead to much looser and less accurate diagnosis.