New York University's independent student newspaper, established in 1973.

Washington Square News

New York University's independent student newspaper, established in 1973.

Washington Square News

New York University's independent student newspaper, established in 1973.

Washington Square News

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American Psychiatric Association overdiagnoses mental disorders

The American Psychiatric Association has planned to release the latest edition of the Diagnostic and Statistical Manual of Mental Disorders this coming May. This will be the fifth edition and will include some of the most dramatic changes yet. There are too many for me to fully explore, but I will touch on some of the major edits.

One common criticism is the increased risk of overdiagnosis because the criteria for some existing disorders have become broader, such as the standard for depression. People inside and outside of the APA have also made proposals for new disorders like Negativistic (Passive Aggressive) Personality Disorder, Internet Addiction Disorder, adult forms of ADHD and behavioral disorders specific to gambling. Some critics say these disorders just provide excuses to sell more drugs and should be redefined or dropped entirely.

Others believe it is excessive to diagnose a disorder based on the fact that someone has an undesirable trait, such as passive aggression or hypersexuality. I shared suspicions of overdiagnosis when I discovered that obesity was once on the table for becoming an eating disorder in the DSM-5. Designating obesity as an eating disorder would obviously cause problems with overdiagnosis in the United States, and people would feel pressured to buy drugs to remedy their new disorder. However, obesity does not seem to be up for discussion anymore and, with luck, some of these other so-called disorders may be dropped before May.

There are also massive restructuring changes, including the integration of autism and Asperger’s syndrome into the manual, as well as eliminating the five-axis system. I was satisfied with the five axes and do not fully understand the reason for eliminating them. The five axes organize the analysis of mental illnesses, personality disorders and mental retardation, medical conditions, psychological factors and global assessment of functioning. I found that having these five factors allowed for a rich assessment of patients because it considered contributing factors and their interaction with the disorder in question.

I believe these looming changes to the DSM represent outside influences on the APA and society’s tendency to regard abnormality as something that must be changed if possible. People have often thought, “If only we could diagnose all the people that annoy us with Annoying Personality Disorder and then have psychiatrists prescribe medication that would not make them annoying anymore. Wouldn’t that be nice?” Unfortunately, sometimes overdiagnosis is a watered-down attempt to do just that. As for the changes in restructuring, the only ones that could be problematic are the dimensional approach to personality disorders and the abandonment of the five-axis system, all of which have been fiercely debated.

A version of this article appeared in the Wednesday, March 5 print edition. Joseph Rauch is a contributing writer. Email him at [email protected]

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  • W

    WALTER J. HILL,M.D.Mar 11, 2013 at 2:38 pm

    OVER A PERIOD OF 45YRS PRACTICE OF PSYCHIATRY IT HAS ,OF COURSE BEEN THE INTEREST OF THE PHARMACEUTICAL INTEREST TO MAKE PROFOUND PROFITS OFF THE VARIOUS PSYCHIATRIC DIAGNOSES. NEVERTHELESS THEREIS THE CONVENTIONAL ACCEPTANCE IN THE MEDICAL PROFESSION THAT DIAGNOSES MUST BE MADE.

    Reply
  • J

    jamesMar 8, 2013 at 3:08 pm

    Keep in mind that part of the criteria —-repeated failures to stop—– before anyone starts rationalizing. Because the DSM5 carries a lot of weight there ought to be oversight so things like Hypersexual disorder being dismissed without a word as to why -does not happen.
    Regards to all

    Reply
  • M

    Maurine MeleckMar 6, 2013 at 8:55 pm

    No surprise that the APA has outside influences. Diagnose and pill them. However, my expertise is in autism. Autism is NOT a mental disorder and does not belong in the DSM and never did. That is a huge problem. Not only will the autism changes affect thousands who will no longer be eligible for services, but they never belonged in this book from the start. Autism is a neurodevelopmental and metabolic disorder/ All these educated people in the APA and they still cannot get it right. What…

    Reply
  • K

    Kim MillsMar 6, 2013 at 12:49 pm

    The DSM is not published by the American Psychological Association. It is published by the American Psychiatric Association: http://psychiatry.org/practice/dsm

    I hope the editor will correct this error promptly.

    Reply