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.

Outlines

00:00

📚 The Evolution of the DSM and Its Impact

Suzan Lross introduces her research on the DSM for mental health providers. She discusses the historical context, starting with the unpreparedness of mental health providers for soldiers returning from World War II. She highlights the significance of the DSM-3 released in 1980, which gained acceptance from the public, insurance companies, and educational institutions. She also mentions the FDA's changes in drug approval laws as a result of the DSM-3. The DSM-5 was released in 2013, with a new version in 2022, indicating that the DSM is a dynamic, evolving document. It is scrutinized by various entities, including the media, insurance companies, and mental health professionals.

05:01

🧠 Critiques and Challenges of the DSM

Suzan outlines the main arguments and critiques against the DSM, focusing on the reliability and validity of psychiatric diagnoses. She explains the complexity of identifying the root causes of psychiatric disorders due to the brain's uniqueness and the limitations in current neurological understanding. There is a call for integrating other sciences like physiology, genetics, imaging, and cognitive data into psychiatric diagnoses. However, the high cost of such studies, exemplified by a $1,200 genetic test, makes it challenging. Suzan references a study by Fredman showing inconsistencies in diagnoses by psychiatrists, which she attributes partly to the rigid computer-generated scripts used in the study.

🔍 Medicalization and Overmedication Concerns

Suzan addresses concerns about the medicalization of normal life events and the potential for overmedication. She discusses how life events, which individuals typically overcome, are sometimes seen in clinical practice when patients get stuck in their recovery. Some of these events are listed in the DSM. She highlights the issue of overmedication, noting that psychiatrists, who are medical doctors, usually start patients on low doses and adjust as needed. There is a particular concern with diagnoses like autism, ADHD, and social anxiety, where media coverage can lead to a surge in patients seeking diagnoses, potentially leading to diagnostic shortcuts by clinicians. However, therapists are trained to avoid this pitfall.

📖 The DSM as a Tool and a Living Document

Suzan concludes by emphasizing the DSM's role as a valuable tool for mental health providers, offering updated information on mental health disorders. She describes the DSM as a snapshot of a living, breathing document that is continuously updated. She notes that the DSM-7 is kept in a looser format to accommodate the needs of health insurance companies, the media, and private individuals. Despite its imperfections and ongoing evolution, the DSM remains a critical resource in the field of mental health.

Keywords

💡DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication by the American Psychiatric Association that provides a common language and standard criteria for the classification of mental disorders. It is central to the video's theme as it discusses the evolution and importance of the DSM in mental health treatment, insurance, and education. The script mentions the pivotal changes in DSM-III in 1980 and the more recent DSM-5 in 2013, highlighting its role as a 'living, breathing document' that evolves with new research.

💡Mental Health Providers

Mental health providers are professionals who offer treatment and support for individuals with mental health disorders. The video script discusses the unpreparedness of these providers for the mental health issues faced by soldiers returning from World War II, emphasizing the historical context of mental health treatment and the development of the DSM to better equip providers.

💡Pharmaceutical Drugs

Pharmaceutical drugs are medications used to treat various health conditions, including mental disorders. The script refers to the FDA's change in laws post-DSM-III, which led to the approval of drugs for specific diseases or disorders, illustrating the influence of the DSM on medication development and prescription practices.

💡Neurology

Neurology is the branch of medicine dealing with disorders of the nervous system. The video script contrasts neurology with psychology, noting that our understanding of the neurological basis of psychiatric disorders is still limited, which is a point of contention in the validity and reliability of DSM diagnoses.

💡Genetics

Genetics refers to the study of genes, genetic variation, and heredity in living organisms. The script discusses the potential role of genetics in psychiatric diagnosis, mentioning the high cost and limited research in this area, which contributes to the ongoing debate about the scientific backing of DSM diagnoses.

💡Psychiatric Diagnosis

A psychiatric diagnosis is the identification of a mental disorder based on established criteria. The video script explores the complexities and criticisms of psychiatric diagnoses made according to the DSM, including the variability in diagnoses given by different psychiatrists and the potential for medicalization of normal life events.

💡Medicalization

Medicalization refers to the process by which non-medical problems become defined and treated as medical conditions. The script raises concerns about the medicalization of normal life events within the DSM, which can lead to over-diagnosis and over-medication.

💡Over-Medication

Over-medication is the prescribing of more medication than is necessary or beneficial. The video script expresses worry about over-medication in the context of psychiatric treatment, where psychiatrists, being medical doctors, may start patients on medication and adjust dosages as needed.

💡Neurocognitive

Neurocognitive refers to cognitive processes that are influenced by neurological factors. The script cites a study by Fredman, where neurocognitive scores were used to evaluate the consistency of psychiatric diagnoses among different psychiatrists, highlighting the challenges in achieving diagnostic reliability.

💡Insurance Companies

Insurance companies play a significant role in healthcare by providing coverage for medical expenses. The video script mentions that the DSM is scrutinized by insurance companies, which use the manual to determine coverage for mental health treatments, emphasizing the DSM's impact on healthcare policies and practices.

💡Mental Health Care Professionals

Mental health care professionals encompass a range of individuals involved in the treatment and care of those with mental health disorders, including psychiatrists, psychologists, and therapists. The script discusses the role of these professionals in critiquing and utilizing the DSM, as well as their training to overcome potential diagnostic shortcuts.

Highlights

Suzan Lross' research on the DSM for mental health providers and its historical evolution.

Mental health providers were unprepared for WWII soldiers' treatment due to institutional focus.

Release of DSM-III in 1980 marked a pivotal shift in public, insurance, and educational acceptance.

FDA laws changed post-DSM-III to approve pharmaceuticals for specific diseases or disorders.

DSM-5 released in 2013 and a new version in 2022, illustrating the DSM as an ever-evolving document.

Critique of DSM's reliability and validity, questioning the root cause of psychiatric disorders.

Neurology's infancy compared to psychology, affecting understanding of brain development.

Critique suggesting the need for backing psychiatric diagnosis with other sciences like genetics and imaging.

The argument that diagnosis and treatment remain consistent regardless of the root cause.

The high cost of genetic testing and its limited scope as a diagnostic tool.

Lack of study on the correlation between physiology, genetics, and brain imaging in mental disorders.

Fredman's study showing inconsistent diagnoses by different psychiatrists.

Concerns about medicalization of normal life events and its impact on diagnosis.

Over-medication worries due to psychiatrists' medical background and practice.

The issue of diagnostic overload in popular mental health conditions.

Therapists' training to overcome potential shortcuts in diagnosis due to popular trends.

DSM as a valuable tool for providers, offering updated information on mental health disorders.

The DSM's format evolution from rigid to loose to accommodate various stakeholders.

The DSM as a snapshot of a living, breathing document subject to change.

Transcripts

hi my name is suzan lross and I did my

research on the DSM for mental health

providers um in the history of the

DS

DSM um it's important to know that the

soldiers that were retured from World

War

II um the mental health providers were

not prepared for treatment for these

patients

um mental health was typically seen in

a

institution and that was the

only way that patients were seen um the

DSM 3 was released in 1980 and this was

really pivotal pivotal because it was

radically accepted by the public

usland insurance compan

and even educational institutions

textbooks were based on the

dsm3 um the next important thing the

FDA their laws

changed as a result of the

dsm3 and only pharmaceutical drugs were

approved when they had they were made

for a specific disease or

disorder um then most recently the ds75

was released in 2013 and a new version

was released in

2022 so my argument is the DSM is a

living breathing

document that is Ever Changing um as

improvements are made new research as

new research is verified

um the DSM is scrutin by scrutinized by

the media insurance companies public and

the US government and other Mental

Health Care Professionals as well

because they think of the DSM as an

encyclopedia type

document

um there's a clear difference between

the people that make the DSM and the

people

that critique the

DSM and so I'm going to explain that

arguments they have the re liability and

validity of the DSM

is one of the arguments is the itology

or the root cause of

psychiatric um

disorders they think that by finding the

root CA

it'll show how

the the disorder has developed but it

can develop in many different ways

because everybody's brains are different

um currently we don't have enough

information about the human brain to um

understand how it is developed in the

mind in the human

brain

um because is neurology is even newer

than psychology is

um there's

another um critique is that there should

be other Sciences

backing the psych psychiatric diagnosis

like a

physiology genetics Imaging or cognitive

data um mology

doesn't negate your like the root cause

of your

psychiatric diagnosis doesn't change the

fact that you have the diagnosis and no

matter how you got the diagnosis like

where it came from you the treatment for

the diagnosis is still the same and so

it um

okay and if you want to provide a

diagnosis through physical symptoms

genetics Imaging or other disciplines I

once had a genetic test and they were

testing one little piece of my genome

and the test with the genetic test for

one genome was

$1,200 before insurance and so if you're

trying to find

out if you have a genetic predisposition

to a

diagnosis then it would be very very

expensive and then if you're doing other

Imaging it's not very cost effective and

that is why it has not been studied it's

because it's so

expensive um it would be really

interesting to see if patients with the

same or clients with the same disorders

had similar physiology or genetics or

Imaging in their

brain um but it hasn't been studied as

yet um fredman did a study

of where clients were evaluated by three

different

psychiatrists and they did not diagnose

the clients

similarly 28 % of

the

um clients less than that were not

diagnosed

with um depression and the

neurocognitive scored of 78 which is a

moderate Psych in Psychiatry is a

moderate reading of

positivity and the 28 is considered

important um the psychiatrists were

given computer generated script that

they had to follow and they couldn't

deviate from that at all and I believe

that contributed to the results of the

study um there's also a concern about

medicalization of normal life and the

problem with this is it gets a little

tricky there's like lots of life events

that um are usually overcome by an

individual and then these life events

also they're seen by providers in a

clinic because they get stuck in some

part of their recovery process and so

some life events are actually listed in

the DSM

because these patients are typ we seen

in

practice

um there's also the worry of over

medication um psychiatrists are actually

medical doctors that have gone to

medical school with an MD or a

do and their best practice is to start

the patient on Loos and adjust from

there unless there's extreme

circumstances um there's worry over nois

and

treatment um especially

autism autism spectrum disorder ADHD and

social

anxiety um

usually a diagnosis

is um shown in the news and then

patients who have symptoms come in to

get diagnosed and when you have a whole

bunch of people coming in for the same

diagnosis sometimes you can get a

humoristic overload

but from the clinicians end and it just

is like a shortcut in your brain to give

them a diagnosis but therapists are

trained to overcome this and

so as part of their therapy training um

the DS is a great tool for providers

that includes updated information on

mental health disorders it's the

snapshot of a living breathing

document and um the ds7 is kept in a

looser

format as opposed to a tight tighter

format because health insurance

companies the media and private

individuals like to use the

DSM it's important to remember that it

is changing

document thank you for your time