DSM Presentation - S. Lara Cross

Summary

Suzan Lross discusses the evolution of the Diagnostic and Statistical Manual of Mental Disorders (DSM), highlighting its pivotal role since the DSM-III in 1980. She argues that the DSM is a dynamic document, subject to scrutiny and change with new research. Critiques include its reliance on symptomology rather than underlying causes and the potential for medicalizing normal life events. The DSM's influence on insurance, education, and treatment is noted, along with concerns about overmedication and diagnosis overload.

Takeaways

• 📚 The DSM (Diagnostic and Statistical Manual of Mental Disorders) has evolved significantly over time, reflecting changes in understanding and treatment approaches.
• 🏥 Post-World War II, mental health providers were unprepared for the scale of mental health issues faced by returning soldiers, highlighting the historical context of mental health care.
• 🌟 The release of DSM-3 in 1980 was pivotal as it was widely accepted by the public, insurance companies, and educational institutions, setting a new standard for mental health diagnosis.
• 💊 Changes in FDA laws following DSM-3 emphasized the importance of pharmaceutical drugs being approved for specific diseases or disorders, impacting treatment protocols.
• 📈 The DSM is described as a 'living, breathing document' that is subject to ongoing scrutiny and revision in light of new research and societal perspectives.
• 🤔 There is a debate over the reliability and validity of the DSM, with critics questioning its approach to identifying the root causes of psychiatric disorders.
• 🧬 Some argue that psychiatric diagnoses should be backed by other sciences such as physiology, genetics, and imaging, not just psychology.
• 💼 The cost and practicality of alternative diagnostic methods, such as genetic testing or brain imaging, are significant barriers to their widespread use in mental health diagnosis.
• 👥 A study by Fredman found inconsistencies in diagnoses given by different psychiatrists, suggesting variability in the application of the DSM.
• 🛑 Concerns about the medicalization of normal life events are raised, where some events are included in the DSM because they frequently present in clinical practice.
• 💊 There is a worry about over-medication, with psychiatrists being cautious about starting patients on medication and adjusting dosages as needed.
• 🧐 The DSM serves as a valuable tool for providers, offering a snapshot of current understanding and treatment approaches for mental health disorders.

Q & A

What was the situation of mental health treatment for soldiers returning from World War II?

Mental health providers were not prepared for treatment of these patients, as mental health was typically seen only in institutions.

When was the DSM-III released and what was its significance?

The DSM-III was released in 1980 and was pivotal as it was widely accepted by the public, insurance companies, and educational institutions, with textbooks being based on it.

How did the release of DSM-III affect the FDA's laws?

The release of DSM-III led to changes in FDA laws, where only pharmaceutical drugs were approved when they were made for a specific disease or disorder.

What is the most recent version of the DSM and when was it released?

The most recent version of the DSM, referred to as 'DSM-5', was released in 2013, with a new version released in 2022.

Why is the DSM considered a 'living, breathing document'?

The DSM is considered a 'living, breathing document' because it is ever-changing, with improvements and new research being incorporated as they are verified.

What is one of the main arguments against the DSM regarding the etiology of psychiatric disorders?

One of the main arguments is the lack of a clear etiology or root cause of psychiatric disorders, as everyone's brain is different and develops disorders in various ways.

Why is it currently difficult to find the root cause of psychiatric disorders?

It is difficult because neurology is a newer field than psychology, and there is not enough information about the human brain to understand the development of disorders.

What is another critique of the DSM regarding psychiatric diagnosis?

Another critique is that psychiatric diagnoses should be backed by other sciences such as physiology, genetics, imaging, or cognitive data.

Why is it argued that the root cause of a psychiatric diagnosis doesn't change the treatment approach?

Regardless of how the diagnosis was made or where it came from, the treatment for the diagnosis remains the same, which is why the root cause doesn't change the treatment approach.

What is the concern with using genetic tests for psychiatric diagnoses and their cost implications?

Genetic tests for psychiatric diagnoses can be very expensive, with a single test costing $1,200 before insurance, making it cost-ineffective for widespread use.

What study by Fredman showed regarding the consistency of psychiatric diagnoses by different psychiatrists?

Fredman's study showed that when clients were evaluated by three different psychiatrists, there was a lack of consistency in diagnoses, with less than 28% of clients being diagnosed similarly.

What is the concern about the medicalization of normal life events in the context of the DSM?

The concern is that life events, which individuals usually overcome, are sometimes listed in the DSM because they are seen in practice when patients get stuck in their recovery process, potentially leading to over-medicalization.

What is the worry regarding over-medication in psychiatric treatment?

The worry is that psychiatrists, being medical doctors, may start patients on medication and adjust from there, which could lead to over-medication without considering other therapeutic approaches.

How does the DSM serve as a tool for mental health providers?

The DSM serves as a tool for providers by providing updated information on mental health disorders, acting as a snapshot of a living, breathing document.

Why is the DSM-5 kept in a 'looser' format compared to previous versions?

The DSM-5 is kept in a 'looser' format to accommodate the needs of health insurance companies, the media, and private individuals who use the DSM, as it is an ever-changing document.