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Summary of Concerns Regarding the DSM-5 as Currently Proposed

Summary of Concerns in Open Letter

Division 32 Committee on DSM-5
Contact Person: David N. Elkins, President, Division 32 davidnelkins@hotmail.com

The below should not be substituted for the “official position” of Division 32, which can be found in the full Open Letter at http://www.ipetitions.com/petition/dsm5/

Liberal changes—some with little to no basis in the scientific literature—may be made to the content of the DSM (see www.dsm5.org)

Though others (e.g., the British Psychological Society, American Counseling Association, and prominent psychiatrists) have critiqued these proposals, American psychologists have remained relatively silent. However, our work is heavily affected by any changes to the manual.

Therefore, our goal is to provide a unified response on the part of American psychologists as a professional community.

Our letter compliments the Task Force on attempts to update the manual in accordance with science, but states that we are still concerned about some proposed changes that have no basis in the scientific literature. These changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.

Areas of particular concern include:

  • Lowering of diagnostic thresholds, which may expand the number of people who meet criteria for certain disorders and lead to an increase in false-positive diagnoses.
  • Vulnerable populations: Certain proposed revisions may lead to misuse in vulnerable populations, such as children and the elderly. This is particularly concerning if some of the newly proposed disorders are to be treated with neuroleptics, which are known to have dangerous side-effects.
  • Sociocultural variation – The proposed wording of the new definition of mental disorder is ambiguous, and if read literally may risk resulting in the labeling of sociopolitical deviance as mental disorder.
  • Personality disorders: The personality disorders section is perplexing. A member of the Personality Disorders Workgroup 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 facts” (Livesley, 2010).
  • Conditions proposed by outside sources include questionable suggestions such as Apathy Syndrome, Internet Addiction Disorder, and Parental Alienation Syndrome.
  • Various changes throughout the manual place subtle emphasis on medico-physiological theory. DSMs III and IV were said to be “atheoretical,” i.e., useable by practitioners from any theoretical background. When viewed together, some of the proposed changes seem to depart from DSM‘s former “atheoretical” stance in favor of a pathophysiological model. This move is problematic because growing evidence suggests that psychopathology cannot be reduced to purely biological explanations and that psychotropic medications pose substantial iatrogenic hazards.

We conclude by voicing agreement with the British Psychological Society that:

  •  “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”
  • “The putative diagnoses presented in DSM-V are clearly based largely on social norms, with ‘symptoms’ that all rely on subjective judgments, with little confirmatory physical ‘signs’ or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.”
  • “… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”
  • “There is a need for ―a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with ‘normal’ experience‖ and the fact that strongly evidenced causal factors include ―psychosocial factors such as poverty, unemployment and trauma.”
  • “An ideal empirical system for classification would not be based on past theory but rather would ― begin from the bottom up – starting with specific experiences, problems or ‗symptoms‘ or ‗complaints‘.”

 

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