Is the DSM history?

[discogenic]

http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing/

 

This must be pretty big news in psychiatry.

[discogenic]

http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing/

 

This must be pretty big news in psychiatry.

[discogenic]

http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing/

 

This must be pretty big news in psychiatry.

[villa6]

Wow! First time I have heard about this. Thanks for sharing.

[villa6]

Wow! First time I have heard about this. Thanks for sharing.

[villa6]

Wow! First time I have heard about this. Thanks for sharing.

[D.C.]

Why not just use the ICD? Chapter V?

[D.C.]

Why not just use the ICD? Chapter V?

[D.C.]

Why not just use the ICD? Chapter V?

[Avalon]

Good Morning,

 

This has been an interesting evolution, to say the least. I have a lengthy background in mental health (I have been a licensed clinical psychologist for over 20 years and am a former psychology professor). Two quick thoughts relative to this development:

 

1) The DSM is, and has been since Robert Spitzer's influence with the DSM-III-R, a descriptive system of diagnosis. This means that the criteria sets presented in the text describe patterns of behavior (including affective and cognitive "behavior"). Clinicians then use these criteria sets to match, as closely as possible, the patient's behavior and thus assign a "diagnosis." While this may be a somewhat reliable system, meaning that multiple clinicians looking at the same patient and observing the same behavior, will often (but not always) assign the same label (a DSM-IV-TR diagnosis) to describe the patient's presentation, this does not validate the presumed underlying disorder. Inter-rater reliability is, by the way, notoriously low (~ 40%) with some diagnoses contained in the DSM-IV-TR. Nonetheless, the important point here is that reliable use of a taxonomy to classify people's behavior is not the same thing as validating the diagnosis itself; this brings us to the second point.

 

2) If every diagnosis contained in the DSM throughout its evolution since 1952 was a valid disease process, then why have diagnoses been sequentially deleted from subsequent editions? If the label that we use to describe a pattern of behavior truly represents an underlying disease process, then what happened to those diseases when the authors revised the DSM and excluded those "diseases"? There are multiple examples of former diagnoses that have been deleted from the DSM taxonomy. I am not just speaking of homosexuality, for example; its deletion represented a shift in social norms, and was actually somehwat contentious and (surprise) political within the APA. Further, the number of mental health diagnoses contained in the DSM from the first edition to the soon-extected fifth edition, has virtually exploded, from just over 100 in DSM-I, to just shy of 300 in DSM-IV, which is expected to be roughly stable, although with numerous shifts in categorization and criteria sets, in DSM-V. I'm not suggesting that we have not made significant gains in our understadning of psychiatric illnesses, but I do wonder why it has become so very easy to pathologize what are likley variants of normal behavior, and to then be justified in placing a label on these variations.

[Avalon]

Good Morning,

 

This has been an interesting evolution, to say the least. I have a lengthy background in mental health (I have been a licensed clinical psychologist for over 20 years and am a former psychology professor). Two quick thoughts relative to this development:

 

1) The DSM is, and has been since Robert Spitzer's influence with the DSM-III-R, a descriptive system of diagnosis. This means that the criteria sets presented in the text describe patterns of behavior (including affective and cognitive "behavior"). Clinicians then use these criteria sets to match, as closely as possible, the patient's behavior and thus assign a "diagnosis." While this may be a somewhat reliable system, meaning that multiple clinicians looking at the same patient and observing the same behavior, will often (but not always) assign the same label (a DSM-IV-TR diagnosis) to describe the patient's presentation, this does not validate the presumed underlying disorder. Inter-rater reliability is, by the way, notoriously low (~ 40%) with some diagnoses contained in the DSM-IV-TR. Nonetheless, the important point here is that reliable use of a taxonomy to classify people's behavior is not the same thing as validating the diagnosis itself; this brings us to the second point.

 

2) If every diagnosis contained in the DSM throughout its evolution since 1952 was a valid disease process, then why have diagnoses been sequentially deleted from subsequent editions? If the label that we use to describe a pattern of behavior truly represents an underlying disease process, then what happened to those diseases when the authors revised the DSM and excluded those "diseases"? There are multiple examples of former diagnoses that have been deleted from the DSM taxonomy. I am not just speaking of homosexuality, for example; its deletion represented a shift in social norms, and was actually somehwat contentious and (surprise) political within the APA. Further, the number of mental health diagnoses contained in the DSM from the first edition to the soon-extected fifth edition, has virtually exploded, from just over 100 in DSM-I, to just shy of 300 in DSM-IV, which is expected to be roughly stable, although with numerous shifts in categorization and criteria sets, in DSM-V. I'm not suggesting that we have not made significant gains in our understadning of psychiatric illnesses, but I do wonder why it has become so very easy to pathologize what are likley variants of normal behavior, and to then be justified in placing a label on these variations.

[Avalon]

Good Morning,

 

This has been an interesting evolution, to say the least. I have a lengthy background in mental health (I have been a licensed clinical psychologist for over 20 years and am a former psychology professor). Two quick thoughts relative to this development:

 

1) The DSM is, and has been since Robert Spitzer's influence with the DSM-III-R, a descriptive system of diagnosis. This means that the criteria sets presented in the text describe patterns of behavior (including affective and cognitive "behavior"). Clinicians then use these criteria sets to match, as closely as possible, the patient's behavior and thus assign a "diagnosis." While this may be a somewhat reliable system, meaning that multiple clinicians looking at the same patient and observing the same behavior, will often (but not always) assign the same label (a DSM-IV-TR diagnosis) to describe the patient's presentation, this does not validate the presumed underlying disorder. Inter-rater reliability is, by the way, notoriously low (~ 40%) with some diagnoses contained in the DSM-IV-TR. Nonetheless, the important point here is that reliable use of a taxonomy to classify people's behavior is not the same thing as validating the diagnosis itself; this brings us to the second point.

 

2) If every diagnosis contained in the DSM throughout its evolution since 1952 was a valid disease process, then why have diagnoses been sequentially deleted from subsequent editions? If the label that we use to describe a pattern of behavior truly represents an underlying disease process, then what happened to those diseases when the authors revised the DSM and excluded those "diseases"? There are multiple examples of former diagnoses that have been deleted from the DSM taxonomy. I am not just speaking of homosexuality, for example; its deletion represented a shift in social norms, and was actually somehwat contentious and (surprise) political within the APA. Further, the number of mental health diagnoses contained in the DSM from the first edition to the soon-extected fifth edition, has virtually exploded, from just over 100 in DSM-I, to just shy of 300 in DSM-IV, which is expected to be roughly stable, although with numerous shifts in categorization and criteria sets, in DSM-V. I'm not suggesting that we have not made significant gains in our understadning of psychiatric illnesses, but I do wonder why it has become so very easy to pathologize what are likley variants of normal behavior, and to then be justified in placing a label on these variations.

[discogenic]

Good Morning,

 

This has been an interesting evolution, to say the least. I have a lengthy background in mental health (I have been a licensed clinical psychologist for over 20 years and am a former psychology professor). Two quick thoughts relative to this development:

 

1) The DSM is, and has been since Robert Spitzer's influence with the DSM-III-R, a descriptive system of diagnosis. This means that the criteria sets presented in the text describe patterns of behavior (including affective and cognitive "behavior"). Clinicians then use these criteria sets to match, as closely as possible, the patient's behavior and thus assign a "diagnosis." While this may be a somewhat reliable system, meaning that multiple clinicians looking at the same patient and observing the same behavior, will often (but not always) assign the same label (a DSM-IV-TR diagnosis) to describe the patient's presentation, this does not validate the presumed underlying disorder. Inter-rater reliability is, by the way, notoriously low (~ 40%) with some diagnoses contained in the DSM-IV-TR. Nonetheless, the important point here is that reliable use of a taxonomy to classify people's behavior is not the same thing as validating the diagnosis itself; this brings us to the second point.

 

2) If every diagnosis contained in the DSM throughout its evolution since 1952 was a valid disease process, then why have diagnoses been sequentially deleted from subsequent editions? If the label that we use to describe a pattern of behavior truly represents an underlying disease process, then what happened to those diseases when the authors revised the DSM and excluded those "diseases"? There are multiple examples of former diagnoses that have been deleted from the DSM taxonomy. I am not just speaking of homosexuality, for example; its deletion represented a shift in social norms, and was actually somehwat contentious and (surprise) political within the APA. Further, the number of mental health diagnoses contained in the DSM from the first edition to the soon-extected fifth edition, has virtually exploded, from just over 100 in DSM-I, to just shy of 300 in DSM-IV, which is expected to be roughly stable, although with numerous shifts in categorization and criteria sets, in DSM-V. I'm not suggesting that we have not made significant gains in our understadning of psychiatric illnesses, but I do wonder why it has become so very easy to pathologize what are likley variants of normal behavior, and to then be justified in placing a label on these variations.

 

I don't want to sound cynical, and I admittedly know very little about psychiatry, but it's no secret that psychiatric drug sales is huge business and has been on an upward trajectory. I've read that 1 in 5 Americans take one of these medications and that targeting kids for these meds is seen (in the business world) as the next frontier. And these guidelines have been criticized for the cozy relationship between the experts writing them and the lucrative arrangements they have with the pharmaceutical manufacturers. Perhaps these are factors in why so many behaviors are now 'pathologized', as you say.

[discogenic]

Good Morning,

 

This has been an interesting evolution, to say the least. I have a lengthy background in mental health (I have been a licensed clinical psychologist for over 20 years and am a former psychology professor). Two quick thoughts relative to this development:

 

1) The DSM is, and has been since Robert Spitzer's influence with the DSM-III-R, a descriptive system of diagnosis. This means that the criteria sets presented in the text describe patterns of behavior (including affective and cognitive "behavior"). Clinicians then use these criteria sets to match, as closely as possible, the patient's behavior and thus assign a "diagnosis." While this may be a somewhat reliable system, meaning that multiple clinicians looking at the same patient and observing the same behavior, will often (but not always) assign the same label (a DSM-IV-TR diagnosis) to describe the patient's presentation, this does not validate the presumed underlying disorder. Inter-rater reliability is, by the way, notoriously low (~ 40%) with some diagnoses contained in the DSM-IV-TR. Nonetheless, the important point here is that reliable use of a taxonomy to classify people's behavior is not the same thing as validating the diagnosis itself; this brings us to the second point.

 

2) If every diagnosis contained in the DSM throughout its evolution since 1952 was a valid disease process, then why have diagnoses been sequentially deleted from subsequent editions? If the label that we use to describe a pattern of behavior truly represents an underlying disease process, then what happened to those diseases when the authors revised the DSM and excluded those "diseases"? There are multiple examples of former diagnoses that have been deleted from the DSM taxonomy. I am not just speaking of homosexuality, for example; its deletion represented a shift in social norms, and was actually somehwat contentious and (surprise) political within the APA. Further, the number of mental health diagnoses contained in the DSM from the first edition to the soon-extected fifth edition, has virtually exploded, from just over 100 in DSM-I, to just shy of 300 in DSM-IV, which is expected to be roughly stable, although with numerous shifts in categorization and criteria sets, in DSM-V. I'm not suggesting that we have not made significant gains in our understadning of psychiatric illnesses, but I do wonder why it has become so very easy to pathologize what are likley variants of normal behavior, and to then be justified in placing a label on these variations.

 

I don't want to sound cynical, and I admittedly know very little about psychiatry, but it's no secret that psychiatric drug sales is huge business and has been on an upward trajectory. I've read that 1 in 5 Americans take one of these medications and that targeting kids for these meds is seen (in the business world) as the next frontier. And these guidelines have been criticized for the cozy relationship between the experts writing them and the lucrative arrangements they have with the pharmaceutical manufacturers. Perhaps these are factors in why so many behaviors are now 'pathologized', as you say.

[discogenic]

Good Morning,

 

This has been an interesting evolution, to say the least. I have a lengthy background in mental health (I have been a licensed clinical psychologist for over 20 years and am a former psychology professor). Two quick thoughts relative to this development:

 

1) The DSM is, and has been since Robert Spitzer's influence with the DSM-III-R, a descriptive system of diagnosis. This means that the criteria sets presented in the text describe patterns of behavior (including affective and cognitive "behavior"). Clinicians then use these criteria sets to match, as closely as possible, the patient's behavior and thus assign a "diagnosis." While this may be a somewhat reliable system, meaning that multiple clinicians looking at the same patient and observing the same behavior, will often (but not always) assign the same label (a DSM-IV-TR diagnosis) to describe the patient's presentation, this does not validate the presumed underlying disorder. Inter-rater reliability is, by the way, notoriously low (~ 40%) with some diagnoses contained in the DSM-IV-TR. Nonetheless, the important point here is that reliable use of a taxonomy to classify people's behavior is not the same thing as validating the diagnosis itself; this brings us to the second point.

 

2) If every diagnosis contained in the DSM throughout its evolution since 1952 was a valid disease process, then why have diagnoses been sequentially deleted from subsequent editions? If the label that we use to describe a pattern of behavior truly represents an underlying disease process, then what happened to those diseases when the authors revised the DSM and excluded those "diseases"? There are multiple examples of former diagnoses that have been deleted from the DSM taxonomy. I am not just speaking of homosexuality, for example; its deletion represented a shift in social norms, and was actually somehwat contentious and (surprise) political within the APA. Further, the number of mental health diagnoses contained in the DSM from the first edition to the soon-extected fifth edition, has virtually exploded, from just over 100 in DSM-I, to just shy of 300 in DSM-IV, which is expected to be roughly stable, although with numerous shifts in categorization and criteria sets, in DSM-V. I'm not suggesting that we have not made significant gains in our understadning of psychiatric illnesses, but I do wonder why it has become so very easy to pathologize what are likley variants of normal behavior, and to then be justified in placing a label on these variations.

 

I don't want to sound cynical, and I admittedly know very little about psychiatry, but it's no secret that psychiatric drug sales is huge business and has been on an upward trajectory. I've read that 1 in 5 Americans take one of these medications and that targeting kids for these meds is seen (in the business world) as the next frontier. And these guidelines have been criticized for the cozy relationship between the experts writing them and the lucrative arrangements they have with the pharmaceutical manufacturers. Perhaps these are factors in why so many behaviors are now 'pathologized', as you say.

[discogenic]

From today's NYT on this:

http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html?smid=tw-nytimeshealth&seid=auto&_r=1&

[discogenic]

From today's NYT on this:

http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html?smid=tw-nytimeshealth&seid=auto&_r=1&

[discogenic]

From today's NYT on this:

http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html?smid=tw-nytimeshealth&seid=auto&_r=1&

[lingeringmind]

The DSM is a dinosaur. It is nothing more than a collection of observations on symptoms that at first blush, seem somehow connected, but are clearly heterogenous. Hopefully DSM 5 will be the last one based on our observation and the patient's phenomenological report. The future of Psychiatry is in biomarkers, progressively precise imaging, invasive interventions, nanotechnology, etc, not in the mumbo-jumbo of archaic understanding, language and language.