Some of you may be following the development of the forthcoming fifth revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the major book used for psychiatric diagnosis. There has been a lot of criticism due to the secrecy of the process …

10 Comments to
British Psychological Society on DSM-5

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  1. I agree with this. I have dissociative identity disorder, which could be viewed as an illness, or as an amazing coping mechanism which my brain developed as a child to cope with experiences I was not yet mature enough to be able to process. If it was more viewed as the latter by others, especially medical professionals, the stigma for me would be less. I’d feel less like crazy myself.

  2. I have direct experience with the British and American systems of psychotherapy and have greatly benefitted by the sensible and sensitive approach of the British system.

    I suspect that their approach did not evolve through focus groups paid for by Big Pharma.

    Perhaps conscientious mental health providers in the US can consider separating their hands from the pockets of the drug companies and do the right thing by their patients too.

    Well, we can dream about it anyway.

  3. Thank you BPS. The DSM-5 should not be published until, for example, the issue of dissociative identity disorder is resolved. That “disorder” does just what you said – pathologizing normal psychological experiences like dissociation and insists on giving every single thought a name.

    Not a way to foster mental health. A good way, however, to keep women in therapy for decades.

  4. I’ve long taught my students that when a diagnosis requires, for example, at least 3 of 10 of set A, and at least 4 of 8 of set B, the number of ways in which the diagnosis can manifest itself is a problem in combinatorics. This means that the phenomenological range of experience that can be covered by what we assume to be a single “entity” can be quite large, and is quite distinct from the very clear sets of symptoms typical of physical diagnoses. I think this too runs against the medicalisation that the disease model implies.

    For those interested to check, for a set of 8 criteria, there are exactly 70 ways to have exactly 4 different symptoms. For a set of 10 symptoms there are 120 combinations of 3 symptoms. Taking these two single-value sets, we are already at 8400 different manifestations… Then we look at 5 of 8, 6 of 8, etc etc. In Excel/Scalc, =COMBIN(8;4) (8 things 4 at a time)

    • Great point Travis. Alan Kazdin has pointed out that there are 32,647 different ways of being diagnosed with Conduct Disorder (a 15 symptom checklist with 3 or more symptoms being required).

      Interestingly, it says in the beginning of DSM-IV-TR that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways.” (p. xxxi). That just about says it all for me. The diagnostic boundaries don’t discern between having the disorder and not having it!!? And the people who “have” the disorders need not be alike in all important ways. These qualifiers make DSM disorders very unusual medical disorders.

  5. Thank you, thank you, thank you for this! I have long been concerned with the pathologizing of normal human experience and the over-simplification of human problems into “brain disease.” I believe the notion of distressing emotions as indicative of a “chemical imbalance” is brilliant marketing rather than brilliant science. The epidemic of what I call “identity diseases” – ADHD and bipolar disorder most prominently – reflects BigPharma advertising and insurance company profit seeking. I frequently see people who have taken on the diagnosis as a core part of their identities, see thjemselves as “their disease,” and use it, to their great detriment, to explain everything in their lives and behavior. “My bipolar made me do it.” “My ADHD keeps me from doing the work.” They often sincerely believe, as they have been taught, that they cannot change and the only solution is the latest, highly profitable medication. Psychiatry has a vested interest in reinforcing this belief; it is, after all, their magic pen and script writing that allows them to earn $250 for a brief consultation. It is both tragic and immoral that the other mental health professions have bought into this and promote it to an unsuspecting public.

    • “identity disease”, that is brilliant. Thanks for sharing,

      • Thank you. Identity diseases are, I believe, a marketing phenomenon, unintended consequence of the self-help movement, an artifact of the internet. The indicator is when the person comes in talking about “my bipolar” or “my borderline” or my ADHD,” usually with an unconscious air of possessiveness about it. It is clear in their discussion that they see it as who they are more than as a condition they might have. It has become a cornerstone of their essential selves. I know then that one of the goals of therapy will need to be to get them, quite literally, to dis-identify with the condition, to begin to see it as a condition that is there but that is not them. Mindfulness techniques are very helpful with this.

  6. I totally agree that people often use their diagnosis as an excuse and a definition of who they are. This really irritates me. I get angry when people say “you are borderline” or “you are depressed” or “your daughter is ADHD”. We are NOT any of these things. We are humans. We have different ways of life, but we are NOT our “illnesses”

  7. I understand your critiques about the diagnoses but, isn’t there a section in the DSM that mentions that to be able to have a psychiatric diagnosis, the pathology or behavior or whatever you call it has to have an impact on the ability to function of the person?
    I work with many psychiatrist as a social worker in mental health and assist numerous psychiatric evaluations each day. I’ve seen a lot of times where the diagnosis is clear but, because the person is able to function without negative impact from the pathology, the psychiatrist doesn’t give the diagnosis.
    So if you’re able to function normally with your dissociative identity, well you have no place in psychiatry, and psychiatry has no place for you.

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