DSM-5 and Psychiatric Diagnosis Inflation

May 21, 2013, 5:57 pm


The New Crisis in Confidence in Psychiatric Diagnosis. Frances A. Ann Intern Med 2013 May 17 [Epub ahead of print]

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Allen Frances, professor emeritus and former chairman of the Department of Psychiatry at Duke, has long argued that the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) would be a seriously flawed product. He has much credibility on this issue — perhaps along with some potential bias — since he chaired the task force that produced the previous edition, DSM-IV, in 1992.

In this short but interesting article, appearing just as DSM-5 is becoming available, Dr. Frances summarizes his objections. Basically, he argues that DSM-V will accelerate the already alarming trend of psychiatric diagnosis inflation, resulting in an epidemic of false-positive diagnoses and use of unnecessary, potential harmful medications. He points out that this process has been happening at least in the 2 decades since DSM-IV was published:

In the past 20 years, the rate of attention-deficit disorder tripled, the rate of bipolar disorder doubled, and the rate of autism had a more than 20-fold increase.

DSM-5, Frances contends, will make things much worse:

The DSM-5, the recently published firth-edition of the diagnostic manual, ignored this risk and introduced several high-prevalence diagnoses at the fuzzy boundary with normality. With DSM-5, patients worried about having a medical illness will often be diagnosed with somatic symptom disorder, normal grief will be misidentified as major depressive disorder, the forgetfulness of old age will be confused with mild neurocognitive disorder, temper tantrums will be labeled disruptive mood dysregulation disorder, overeating will become binge eating disorder, and the already overused diagnosis of attention-deficit disorder will be even easier to apply to adults thanks to criteria that have been loosened further.

In addition, Frances charges that the entire process that produced DSM-5 was corrupt:

I found the DSM-5 process secretive, closed, and disorganized. Deadlines were consistently missed. Field trials produced reliability results that did not meet historical standards. I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product. The APA refused a petition for an independent scientific review of the DSM-5 that was endorsed by more than 50 mental health associations. Publishing profits trumped public interest.

The issues surrounding DSM-5 have potentially enormous consequences for the field of medical toxicology, since diagnostic inflation may very well result in an exponential increase in prescribing psychotropic drugs such as stimulants and antidepressants.

For those interested in this important topic,  Dr. Frances’s lecture “Diagnostic Inflation: Does Everyone Have a Mental Illness”,  given last year at the University of Toronto, is worth checking out:

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