This video describes my opinion of the Diagnostic and Statistical Manual, specifically the DSM-5. The Diagnostic and Statistical Manual is a classification manual. It has mental health disorder classifications in it and it's used by members of a variety of professions. It's written primarily by psychiatrists and published by the American Psychiatric Association, but it's also used by mental health counselors, psychologists, social workers, marriage and family therapists, as well as other mental health professionals. I'm going to go over what I like about the DSM, some criticisms I have of the DSM, and I'm also going to address some criticisms I've heard from others about the DSM. First, I'll talk about what I like about the DSM. Overall, I'm a fan of the DSM. I think it's generally well organized, it tends to use precise language, and I generally find it to be helpful. I like the way the DSM incorporates current research into the different classifications. Our field is subjective, so of course this is can be limited and we are talking about a complex subject matter, but I think that the DSM does a good job in this area overall. I have a few criticisms of the DSM. It doesn't appear to be a particularly collaborative document in terms of the way it was developed. The development process could be more transparent. I know that there are others that will argue that it was collaborative and it was transparent but I disagree. I realize that it's published by the American Psychiatric Association as I mentioned most of the authors are psychiatrists, but it is used by a number of other professions so it seems reasonable that all the different groups should have some ability to really contribute to what we see in the DSM. Another criticism I have is the way the sections are organized. Although I generally like it, they're not standardized, for example, you can see comorbidity listed in a number of classifications, but not in others. If this information isn't available then list it in the DSM, but specify “unknown.” That helps us to know what areas we need to continue to research. One of the most popular criticisms is that it over-pathologizes the population. It makes too many people eligible for a diagnosis of a mental disorder. Here I have to disagree. I understand that some of the wording and some of the way the classifications are structured could lead to overdiagnosis. You could also argue that some of the language and structure could lead to underdiagnosis. This criticism of the DSM is not about the DSM as much as it is about clinical practice. How the DSM is used is up to a practitioner and doesn't necessarily speak to the quality of the document itself. I think that one of the problems we have with diagnosing in the mental health treatment community is really about clinical skill and judgment and not about how correct or incorrect the DSM is. As clinicians it's our responsibility to look at the DSM and make our own judgment about how reliable or valid the classifications are. I think that the DSM has done a reasonable job in terms of the way it's structured the classifications, and I don't think it's really leaning toward over-pathologizing or underdiagnosing. Another criticism is there are no treatments indicated in the DSM. This is simply a matter of what the DSM is supposed to do. It's a manual full of descriptions of mental disorders and it's not designed to directly inform treatment by providing the treatments right there in the same document. It's designed to inform treatment by allowing us to accurately classify psychopathology and then we can look to the literature and see what treatments would be applicable. Overall, I tend to like the DSM. I think that the way it's arranged makes sense, although of course it could use improvements. I understand there are many others with different opinions and a lot of times with the Diagnostic and Statistical Manual there are strong opinions in both directions. I believe that continued research can help future versions of the DSM become more helpful for our work and mental health treatment.
