Why the Newest Psychiatric Diagnostic Bible Will Be a Boon for Big Pharma
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After the American Psychiatric Association (APA) approved the latest version of its diagnostic bible, the DSM-5, psychiatrist Allen Frances, the former chair of the DSM-4 taskforce and currently professor emeritus at Duke, announced, “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry” (“ A Tense Compromise on Defining Disorders”).
The DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) will be released by the APA in spring 2013. However, Frances states, “My best advice to clinicians, to the press, and to the general public—be skeptical and don't follow DSM-5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication.”
For mental health professionals, this advice from the former chair of the DSM-4 taskforce is shocking—almost as if Colin Powell were to advise U.S. defense and state department employees not to blindly follow all administration orders. Particularly upsetting for Frances is the DSM-5’s pathologizing of normal human grief. On Jan. 7, 2013 in “ Last Plea To DSM-5: Save Grief From the Drug Companies,” Frances wrote, “Making grief a mental disorder will be a bonanza for drug companies, but a disaster for grievers. The decision is also self-destructive for DSM-5 and further undermines the credibility of the APA. Psychiatry should not be mislabeling the normal.”
In the DSM-4, which Frances helped create, there had been a so-called “bereavement exclusion,” which stated that grieving the loss of a loved one, even when accompanied by symptoms of depression, should not be considered the psychiatric disorder of depression. Prior to the DSM-5, the APA had acknowledged that to have symptoms of depression while grieving the loss of a loved one is normal and not a disease. Come this spring, normal human grief accompanied by depression symptoms will be a mental disorder. Psychiatry’s official diagnostic battle is over. Mental illness gatekeepers such as Frances who are concerned about further undermining the credibility of the APA have lost, and mental illness expansionists —psychiatry’s “neocons”— have won.
Other New DSM-5 Mental Illnesses
The pathologizing of normal human grief is not the only DSM-5 embarrassment for Frances. (See his December 2012 blog: “ DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes.”) Get ready to hear about a new mental illness diagnosis for kids: “disruptive mood dysregulation disorder” (DMDD). Frances concludes DMDD “will turn temper tantrums into a mental disorder.”
The APA, somewhat embarrassed by the huge increase of children diagnosed with “pediatric bipolar disorder” in the last two decades, wanted to give practitioners a less severe diagnostic option for moody kids. However, Frances’ fear is that DMDD “will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children....DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.”
The DSM-5 also brings us “minor neurocognitive disorder”—the everyday forgetting characteristic of old age. For Frances, this will result in huge numbers of misdiagnosed people, a huge false positive population of people who are not at special risk for dementia. And he adds, “Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.”
“Binge eating disorder” has also now made it to the major leagues as an official DSM-5 mental illness (moving up from a non-official mental illness status in Appendix B in DSM-4). What constitutes binge eating disorder? Frances reports, “Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called binge eating disorder.”