Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Psychiatry's Contested Bible & New Revision of Diagnosing Addiction
The 1,000 page book plays a major role in the life for someone seeking help for addiction. It encompasses the system that classifies and categorizes diagnoses and symptoms of mental illness and addiction-from diagnosis to the bill your insurance company may send you. The tome, published by the American Psychiatric Association (APA), will most likely find its way to the shelves of any individual or organization paid to provide mental health and addiction care. Due to its widespread influence it has been dubbed “the Bible of psychiatry.”
The APA began this version in the late 90’s with the purpose of improving all mental health care by making diagnosis more medically precise. Big strides in neuroscience have been made in the two decades since the last version. The key changes involve the definitions of the conditions. Addiction has been redefined as a brain disease.
Some specifics on the new changes entail bringing substance abuse and substance dependence into one continuum known as “substance use disorders” ranging on a scale from mild to severe with severity depending on how many of the six criteria are met. Combining the disorders made the changes to criteria necessary for the sake of accuracy, according the the DSM’s research.
Since diagnoses ordinarily depended largely on the patient’s experience and a therapist’s evaluation, these new “objective” scientific scales would help addiction treatment to better coincide with physical medicine, with its numerical diagnostics like blood pressure and cholesterol levels. Also, the scales would help those abusing substances to catch it earlier on, providing treatment before it becomes severe, resulting in better outcomes and lower cost.
However, the DSM-5 has sparked much debate. Critics do not agree that the overhaul is as beneficial as its advocates state. Both sides agree that earlier detection and treatment is a result of the new DSM-5 but not all believe that it will lead to more effective and economical treatment strategies. One main objector is Allen Frances, MD, who oversaw the previous revision to the DSM. He called the newest edition of the manual “clearly unsafe and scientifically unsound” and accusing his own profession of being “in the business of inadvertently manufacturing mental disorders.” He fears that the spectrum approach, which piles first-time abusers with entrenched addicts together, would be “creating a slippery slope that can spread to make a mental disorder of everything we like to do a lot.”
Additionally, an open letter from more than 50 mental health associations claims that evidence does not reinforce the new disorders or measures. It even called for an independent scientific review of the changes to be added to the new manual but the APA refused stating, “There is in fact no outside organization that has the capacity to replicate the range of expertise that DSM-5 has assembled.” Many of the groups responsible for the original open letter are boycotting the new DSM as a result.
Another red flag critics see is the part Big Pharma plays in this. With the increase of substance abusers seeking treatment earlier, clinicians may have the incentive to diagnose depression, anxiety or other common mental illness along with the addiction to have patients prescribed drugs. Psychiatry is consistently one of the main medical specialties to have a very close relationship with drug companies.
Despite the weight it carries, the DSM is not the only authority for addiction diagnosis or treatment. It will remain psychiatry’s bible for the time being per it’s intrinsic involvement with insurance companies (e.g. therapists need to provide a patient's DSM diagnosis on the bill in order to get paid.) but the skepticism and critiquing of it may begin to remove it from being the only say in mental disorders. Patients and providers should also investigate alternative guidelines.