Mental Health Definitions Must Be Helpful, Not Harmful

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Mental Health Definitions Must Be Helpful, Not Harmful

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) Task Force1 is adapting one of the most important medical reference books in the world, and there are concerns that metal health issues are not getting the attention they deserve2.

Changes to the DSM-5 lower the diagnostic thresholds for multiple disorder categories and may lead to inappropriate medical treatment of vulnerable populations. The proposed changes to the definitions of mental disorder also deemphasize sociocultural variation in favor of biological theory3.

This proposal to lower diagnostic thresholds holds many risks.

Diagnostic sensitivity is important given the established limitations and side-effects of popular antipsychotic medications4. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of distress5. As suggested by the Chair of DSM-IV Task Force Allen Frances, among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics6.

The proposed to change the Definition of a Mental Disorder will require clinicians to make a hierarchical decision about perceived causes to diagnose a mental disorder 7.

Given the lack of consensus on even the “primary” causes of mental distress, this proposed change may have the negative result in the labeling of sociopolitical deviance as mental disorder8.

A member of the Personality Disorders Workgroup itself has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts9.”

Similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis10.”

The protection of society, including the prevention of false epidemics, should be more important than creating new categories for existing conditions. But not all practitioners have expertise in clinical decision-making, and will not be able to prevent epidemiological disasters that arise from misguided process.

The proposed content of the DSM-5 threatens to exacerbate longstanding problems with the current system, but there is still time to rework the psychiatric issues in this reference.

Sign the petition and help us ensure a more inductive, descriptive approach to the DSM-5, and call for greater consideration for mental health issues by giving mental health experts a stronger role in the revision process

More on this issue:

  1. American Psychiatric Association (2013), "The People Behind DSM-5."
  2. Cardwell Nuckols, Marlene Morado, "The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5."
  3. Nursing Times (August 2013), "Controversy over DSM-5: new mental health guide."
  4. Risa Kerslake, PsychCentral (26 May 2021), "What Are the Side Effects of Antipsychotic Medications?."
  5. Puneeta Gupta, Meeta Gupta, and Neeraj Koul, Journal of Family Medicine and Primary Care (25 August 2020), "Overdiagnosis and overtreatment; how to deal with too much medicine."
  6. J. C. Wakefield, Epidemiology and Psychiatric Sciences (24 June 2015), "DSM-5, psychiatric epidemiology and the false positives problem."
  7. Substance Abuse and Mental Health Services Administration, CBHSQ Methodology Report (June 2016), "Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet].."
  8. Gavin Crowell-Williamson, Mad in America (3 December 2020), "Study Reveals a Lack of Consensus on ‘Mental Disorders’ Among US Mental Health Professionals."
  9. W. John Livesley, Psychological Injury and Law (December 2010), "Confusion and Incoherence in the Classification of Personality Disorder: Commentary on the Preliminary Proposals for DSM-5."
  10. Eric R. Maisel Ph.D., Psychology Today (28 October 2011), "The DSM-5 Controversy."

The Petition

To the members of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) Task Force,

Changes proposed to the Diagnostic and Statistical Manual of Mental Disorders lower the diagnostic thresholds for multiple disorder categories and may lead to inappropriate medical treatment of vulnerable populations.

The proposed changes to the definitions of mental disorder deemphasize sociocultural variation in favor of biological theory, and pose substantial risks to patients/clients, practitioners, and mental health professions in general.

The proposed to change the Definition of a Mental Disorder will oversimplify the clinician's role in determining whether a mental disorder is present.

Given the current lack of consensus on even the "primary” causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.

It is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress.

I implore you to ensure a more inductive, descriptive approach in the future, and call for greater consideration for mental health in the DSM-5 by giving mental health experts a stronger role in the revision process.

Sincerely,

DEV MODE ACTIVE. BRAND: ars