- DSM-5 is an acronym commonly used for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
- In the 70 years since the first edition was published, the DSM has always been controversial when diagnosing mental disorders.
- The biggest issues with the DSM-5 are that:
- It lacks scientific basis.
- It leads to cultural bias.
- It pathologizes shared human experience.
- The NIMH does not use it for researching mental health.
- It promotes a pharmaceutical approach to treatment.
- Essentially anyone can be diagnosed with a lifetime disorder.
What Is the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published in 2013 by the American Psychological Association (APA), but its roots go back 70 years with:
- The DSM-I published in 1952
- The DSM-II published in 1968
- The DSM-III published in 1980
- The DSM-IV published in 1994
Since it first appeared in 1952, the DSM has been the primary sourcebook for psychiatric diagnoses in the United States. In that time, there has been no shortage of controversy over the DSM-5 in theory, in practice, and within the psychiatry community at large.
In the 1950s, the DSM-I contained around 60 disorders, and even then people criticized its reliability and validity, questioning its scientific basis and the blurry line between normal and abnormal behavior. Still, it gained widespread acceptance among mainstream psychiatrists in the United States.
Today, the DSM-5 remains the predominant authoritative text in psychiatry in the U.S., but the issues with it have become increasingly apparent as the world around us grows more complex.
An Overview of Problems With the DSM-5
1. It Lacks Scientific Basis
Of the 297 mental disorders listed in the DSM-5, almost all of them lack any scientific basis to begin with. The DSM-5 promotes the idea that for most psychological disorders, there is a genetic component, yet there is no known gene variant for about 97% of diagnoses.
The DSM-5 also perpetuates the chemical imbalance theory, which is the idea that mental disorders are caused by an imbalance of chemicals in the brain. However, the theory is entirely hypothetical. Researchers have repeatedly disproven hypotheses related to chemical imbalance causing mental issues in the brain, making it impossible to develop a cohesive theory as represented in the DSM-5.
2. It Presents a Culturally Biased Perspective of Normality
To develop the DSM-5, committees of mental health experts made decisions about disorders based on clusters of symptoms. However, these experts carried with them implicit cultural biases about which behaviors should be considered normal versus abnormal. Most significantly, however, the experts were not aware of their own biases, which in practice has led to arbitrary, and often invalid, diagnoses.
For example, of 14 people responsible for deciding whether to split anxiety and depression into separate diagnoses or not, 5 people voted to split them into two, four voted not to, and five abstained. In practice, however, there is virtually no distinction between anxiety disorders and depressive disorders, and individuals almost always struggle with both.
As a result, there is little scientific foundation for what behavior is considered normal versus abnormal in the DSM-5, since decisions were based more on cultural and political norms than concrete evidence.
3. It Pathologizes Shared Human Experiences
The example in the previous section also highlights the tendency in the DSM-5—and mainstream psychiatry at large—to over-pathologize human behaviors and experiences. Shared human emotions, including sadness, anxiety, dejection, and cultural ambivalence which are part of being human in many contexts, become medicalized and pathologized as disorders based on symptomatology rather than common experience.
5. The NIMH Does Not Use It for Research
Two weeks after the DSM-5 was published in 2013, the National Institute of Mental Health (NIMH) withdrew support for the manual. The NIMH is the largest agency dedicated to the research of mental health, and it has since moved funding away from research based on DSM categories, and NIMH representatives have been outspoken about the need to move away from symptom-based categorization of diagnoses, particularly in the research realm.
6. It Perpetuates Pharmaceutical-First Treatment
The DSM-5 perpetuates a medication-first approach to treatment. 69% of DSM-5 task force members reported that they had ties to the pharmaceutical industry. Many argue that one of the primary reasons anxiety disorders and depressive disorders were split into separate diagnoses is so that psychiatrists could medicate for both issues separately, meaning more money for drug companies.
Furthermore, because the DSM-5 grounds diagnosis in symptomatology, psychiatrists are prone to treating the symptoms the simplest way possible with medication rather than first investigating root issues, such as trauma, social environment, and family dynamics.
7. Anyone Can Be Diagnosed With a Lifetime Label
One of the most glaring issues with the DSM-5 is that based on the diagnostic criteria it proposes, virtually anyone can be diagnosed with a “disorder.” Yet these labels stick for life and have power. Allen Frances—one of the people who coordinated the development of the DSM-IV admits that “the power to label is the power to destroy” and that if “we look hard enough, perhaps everyone will eventually turn out to be more or less sick.”
When these diagnostic labels are misrepresented or arbitrarily applied to individuals, they can create problems worse than those they are intended to treat, such as overdiagnosis and mismedication.
An Alternative to the Current Diagnostic Model
The DSM-5 lays out a diagnostic framework that is highly vertical. It contains hundreds of individual diagnoses based on clusters of symptoms, and each can be individually medicated. The problem with this approach is that it fails to connect underlying issues and account for the sum total of human experience for which there is no “cure.”
Instead of grounding treatment based on groups of symptoms, it can be more beneficial to contextualize symptoms by grounding them in shared human experiences. At PCH, we present an alternative to the current diagnostic model by grouping experiences into six broad categories:
- Anxiety (Neurotic States)
- Depressive States
- Dissociative States
- Borderline States
- Psychotic States
It is important to note that all of these states can be a normal part of human experience while the DSM-5 is prone to labeling them negative states that should be medicated away. In our experience, even negative states can play a positive role in human development by showing us where we are hurting so we know where we need to heal.
Why We Want To Know What Happened to You
At PCH, one of our biggest issues with the DSM-5 is that diagnoses are based on clusters of symptoms rather than shared human experience. By focusing on symptoms rather than experiences, individuals can come to be viewed as no more than a diagnosis, when in reality, each person is a complex human with unique experiences, memories, trauma, and worldviews.
That is why we do not want to know what is “wrong” with you—our team takes the time to learn more about what happened to you and where you are hurting. With this perspective, we are able to approach each individual as more than a diagnosis, but as a unique human being striving to achieve well-being in a complex world. We understand that, and if you are ready for help, find out if PCH is right for you.