The vicissitudes of DSM-V

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the hotly anticipated and oft-delayed newest version of a tome that informs, among other things, the boundaries of psychiatric diagnoses, has finally been approved by its governing body, the American Psychiatric Association. The revision process has been cloaked in mystery and controversy, as an initial proposal to make radical changes — especially in terms of how the mental health field conceptualizes disorders of personality — gave way to pledges of conservatism. At the end of last month, the Times published an article about the new manual’s approach to personality disorders that was oddly devoid of any useful information (especially ironic considering the article’s title, “Thinking Clearly about Personality Disorders”).

Now, Allen Frances — who was integral to the development of the manual’s current edition, DSM-IV — woefully eviscerates the DSM-V in a new blog post. He claims that the new manual has failed to address extant problems even as it creates new issues where previously there were none. He lists his “top ten” disappointments in the DSM-V, and cautions readers to approach the impending volume with skepticism. Therein lies the rub: while many practitioners may choose to selectively value or generally ignore the DSM-V, healthcare systems and pharmaceutical companies tend to be less flexible, and those receiving treatment may have very little say in the matter. The DSM has an air of authority about it, and so in anticipation of those individuals or institutions who will not approach it with a measured or well-informed attitude, the manual should leave as few loopholes as possible for clients to be misdiagnosed, mistreated, or valued less than monetary reimbursements. According to Frances, DSM-V features more such exploits than previous editions, not less, which should be a cause for concern for everyone.


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