Is grief, such as with the loss of a loved one, normal or is it now a diagnosable condition?
Is grief, such as with the loss of a loved one, normal or is it now a diagnosable condition? This is just one of the many questions being asked with the release of the updated Diagnostic and Statistical Manual of Mental Disorders.
In its fifth update, referred to as DSM-5, this is the book which sets forth the standard of making a mental health diagnosis. The changes, coming twenty years after its last revision, are not sitting well with a significant amount of practitioners and sufferers.
Dean Jacques P. Barber, Ph.D. of the Gordon F. Derner Institute of Advanced Psychological Studies at Adelphi University wonders why the American Psychiatric Association (APA) felt so much pressure to publish it when they don’t have the evidence and the research that supports it.
“Is DSM scientifically based? Where is the research to support the enterprise? How reliable and valid are those diagnoses? The evidence supporting the new system is still weak and the question for me again is, what’s the rush,” Dr. Barber stated. “Nevertheless, one may want to keep an open mind about it as we carefully review the changes.” However, he points out a few critiques of the tome:
From the “neurological” point of view, Thomas R. Insel, M.D. Director of the National Institute of Mental Health (NIMH) argues that the DSM does not advance us as it does not provide biological and/or genetic markers for disorders and does not relate them to the brain. Furthermore, the DSM system tends to be phenomenological, focusing on symptoms, rather than on causes.
From the what-one may call the “imperialistic” point of view of DSM, for example, now normal grief may be diagnosable making it harder to define what is normal and what is not. This may lead to more treatment. Anti-psychiatrists among others raised this issue 50 years ago by asking to differentiate between problems in living and psychiatric problems.
“I could not believe that the EPPP [the Examination for Professional Practice of Psychology, licensing exam for a psychologist],” Dr. Barber went on to say, “has already adopted the DSM 5 and told us that it will be used for exam items beginning August 1, 2014, meaning that we ‘ll need to teach it.”
Professor Robert Bornstein, Ph.D., speaks directly to the DSM-5 process for revising the diagnostic criteria for personality disorders. “In this area those involved in formulating updated criteria for DSM-5 undertook a biased and incomplete literature search; in the end the proposed symptom criteria were so completely detached from prevailing scientific evidence that on December 1st, 2012 the American Psychiatric Association Board of Trustees voted down that portion of the proposal in toto–unprecedented in the history of the DSM.”
“That’s the good news,” Dr. Bornstein added. “Here’s the bad news. As a result of APA’s rejection of the new personality disorder proposal, the symptoms that we will use to diagnose personality disorders during the coming years are unchanged from DSM-IV, which was released in 1994. As I tell students in my undergraduate personality disorders seminar here at Adelphi University, the symptom criteria that clinicians now use to diagnose personality disorders have been around longer than most of the people in the class.”
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