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DSM-5 released amidst controversy

May 30, 2013

The new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been officially released amidst major controversy. It is an update on the previous 1994 classification of mental illnesses. The fifth edition of the Manual, intended as a guide to assist clinicians diagnose and treat mental disorders, has received much criticism from the medical community and public alike.

The Manual is divided into three sections:

  • Section one contains an introduction and information on use of the DSM-5
  • Section two provides information and categorical diagnoses
  • Section three provides self-assessment tools and categories that require more research

Overall the DSM-5 retains the same number of mental disorders, however some disorders have been combined with others to form a spectrum, while other disorders have been separated out from existing disorders to stand alone. A few new disorders have also been added to the Manual.

Examples of some of the major changes include:

  • Hoarding is now a distinct disorder, whereas previously it was considered to be a symptom of Obsession Compulsive Disorder (OCD);
  • New additions include binge eating disorder and premenstrual dysphoric disorder; both are commonly diagnosed by clinicians but not included in previous editions;
  • Autism spectrum disorder now incorporates four separate disorders: autism, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder;
  • Major neurocognitive disorder now includes dementia and amnestic disorder;
  • Mild neurocognitive disorder has been added. This addition has received a great deal of criticism as not being significant enough to be included as a disorder;
  • More attention is paid to diagnostic criteria in children and adolescents across a range of disorders in an effort to prevent over-diagnosis in childhood.

One of the main criticisms of the DSM-5  is that diagnostic thresholds have been lowered across the board, making it easier to diagnose a person with a mental disorder and pathologizing normal emotional reactions.

For example, bereavement is now classified as a mental disorder. Previously, bereavement could only be considered a depressive disorder after a two month period had elapsed; the two-month period has since been recognized as unsubstantiated and arbitrary.

Under DSM-5, the two-month bereavement exclusion has been removed and bereavement is now recognized as a severe psychosocial stressor that can cause a major depressive episode in vulnerable individuals.

Advocates for the DSM-5 feel that the inclusion of bereavement as a mental disorder is helpful and draws attention to the fact that symptoms associated with bereavement-related depression respond to the same psychosocial and medication treatments as non–bereavement-related depression. Furthermore, a detailed footnote has been included in this section to assist clinicians in differentiating between bereavement and a major depressive episode.

In general, proponents of the DSM-5 defend the manual stating that, “the DSM-5 reflects (current) knowledge, (and is) not creating knowledge.”

There are many articles that can be read for greater detail. One of them is, “DSM-5 Released: The Big Changes” available on the World of Psychology website. Another interesting perspective is the Globe and Mail article, “When did life itself become a treatable mental disorder?”.

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