Dangerously Behind the Curve: Why the DSM-5 Needs to Be Dumped

The “bible” for mental health clinicians in assigning diagnoses is the Diagnostic and Statistical Manual of Mental Disorders (DSM).  The DSM, currently in its fifth iteration, places mental illness diagnoses into separate categories largely separate from one another. 

It’s difficult to quickly describe just how impactful and serious these diagnoses can be.  The stigma associated with receiving an MI diagnosis can cause a person to lose their job, upend their social life, cost them custody of their children, and many other consequences.  Medications often prescribed for mental illnesses have significant side effects such as heart problems and weight gain/loss just to name a couple.

This is why I was so dismayed as I began to learn that there are serious flaws both in the DSM itself and also how it is used.  I’m writing this today specifically as a warning to anyone receiving an MI diagnosis that they shouldn’t simply accept it at face value, and here’s why…

Many of us, including myself, have received multiple mental illness diagnoses which have similar or overlapping symptoms.  It’s not uncommon to receive many different diagnoses when presenting the exact same symptoms simply based on the subjectivity of the clinician.

I’ve been hospitalized for a couple of mental health emergencies and have received serious diagnoses, such as bi-polar disorder, after being examined by various psychiatrists for no more than ten minutes each time… only to have those diagnoses wiped out later on after more extensive analysis by another doctor. 

The confusion this caused me critically compounded and exacerbated the psychological challenges I faced, thereby significantly hindering my recovery.  I’m unfortunately not even close to being alone in suffering from the problems of validity and reliability in diagnosing mental health problems… and I have to tell you that this really pisses me off.

Experiences such as mine are why many practicing clinicians have questioned the DSM’s methodology for decades.  More recently, there has been an explosion of knowledge regarding brain functions due to advances in genetics research capabilities and scanning technology, such as Functional Magnetic Resonance Imaging.  This fresh data simply do not support the DSM’s categorization of mental health diagnoses into stand-alone silo-like categories.

This has spawned a clinical movement of sorts toward viewing mental health disorders in a dimensional sense along a spectrum according to shared characteristics of risk factors, prevailing symptoms, and consequences.  These clinicians are thinking outside the categorical boxes set up within the DSM in favor of grouping similar disorders along a continuum according to various impacts on the brain. 

Think along the lines of the now fairly well-known Autism spectrum.  If a person is higher-functioning on the spectrum then they’re considered to have Asperger’s syndrome instead of having full-blown Autism.  The fact is, however, that this is a common misconception as these are not truly dichotomous diagnoses in which there are clear lines of demarcation.  They are simply different ways to describe the severity of the essentially the same condition much like there are varying degrees of ankle sprains.

This makes sense to me.  My conditions fit the newer paradigm much better than the DSM-5 methodology.  There’s so much overlap regarding the symptoms of Complex PTSD, Social Anxiety Disorder, Panic Disorder with Agoraphobia, ADHD, Bi-Polar Disorder, and Dysthymia, … all of which I have been diagnosed with at one point or another.   I think (hope?) being “over-diagnosed” in this way will eventually be avoidable with this new theory of dimensionality. 

In spite of the new and relatively unbiased scientific research data, this is amazingly still quite controversial and not close to widely accepted in the mental health community.  I admit that I naturally tend towards innovative thinking and prefer to ride the leading edge of new science when it has been developed using sound research and discovery practices, so maybe these tendencies - not to mention my own absurd and discouraging diagnostic experiences - bias me towards the novel dimensional approach.  

I strongly suggest you read this article in Nature, not to mention the many links I’ve provided above, to get a more in depth explanation of dimensionality versus categorical methodologies.  Then you can make your own educated decision.

You are primarily responsible for your health, mental and otherwise.  Scrutinize any diagnosis you receive, be directly involved in decisions of which treatments you receive, and don’t be afraid to question what you’re told by your therapist or psychiatrist.  If they recoil at your probing or outright dismiss your inquiries, find someone else to treat you.  Therapy and recovery shouldn’t be a one-way street.  Be your own strongest advocate and keep in mind that good clinicians will actually support and encourage your involvement.