DSM-5, controversial update to psych manual, released

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known simply as the DSM-5, was released by the American Psychiatric Association this week amid criticism of the guide’s changes.

The DSM was last updated almost 20 years ago, but many have called into question some of the edits, including the decision to drop Aspberger's syndrome and put it under the umbrella of spectrum autism. 

"The new manual…represents the strongest system currently available for classifying disorders," DSM-5 Task Force chair Dr. David Kipfter said in a statement. "It reflects the progress that we have made in several important areas."

However, Dr. Allen Frances, former chair of the DSM-4 Task Force and one of the biggest critics of the new manual, has advised physicians to use the DSM-5 "cautiously, if at all."

"The weakness is its lack of validity,” said National Institute of Mental Health director Thomas Insel of the new book. “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.” 

As Dr. Paul McHugh, a psychiatry professor at Johns Hopkins and former psychiatrist in chief at Johns Hopkins Hospital, wrote in his critique of the new manual: 

DSM-5 is a missed opportunity to advance the discipline, instruct the public and encourage financial support for needed psychiatric services. Its editors seem willing to waste another decade before dispersing the mysteries of psychiatry and bringing practitioners and patients together in understanding what they are doing and why. 

The new DSM edits include the additions of binge eating disorder and premenstrual dysphoric disorder; the separation of hoarding into its own category separate from OCD; additions to Post Traumatic Stress Disorder’s list of behavioral symptoms; and the altering of the definition of ADHD to allow for diagnosis in adults, among other shifts.

In defense of the book’s edits and the diagnostic methods used to arrive at the information, APA president Dr. Jeffrey Lieberman said: “It can’t create the knowledge, it reflects the current state of our knowledge.” 

“We can’t keep waiting for such breakthroughs (like biomarkers and laboratory tests). Clinicians and patients need the DSM-5 now,” he added.

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