Three major divisions of the American Psychological Association (APA) – the Society for Humanistic Psychology (Division 32), Society for Community Research and Action-Community Psychology (Division 27), and Society for Group Psychology and Psychotherapy (Division 49) – sent an open letter to the DSM-5 Task Force and the American Psychiatric Association expressing several criticisms about DSM-5.
I’ve summarized the concerns below, but the entire document can be located at this link: http://www.ipetitions.com/petition/dsm5/. The three divisions outline their specific reservations as follows:
Lowering of Diagnostic Thresholds
The proposal to lower diagnostic symptom requirements is scientifically premature and holds numerous risks. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. We are particularly concerned about:
•“Attenuated Psychosis Syndrome,” which describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.
•The proposed removal of Major Depressive Disorder’s bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.
•The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.
•The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.
We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example,
•Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions.
•Children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome.
Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with antipsychotic medications, which, as growing evidence suggests, have particularly dangerous side-effects.
Revisions to Existing Disorder Groupings
Several new proposals with little empirical basis also warrant hesitation:
•Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder (DMDD) have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.
•The proposed overhaul of the Personality Disorders is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research.
•The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome” have virtually no basis in the empirical literature.
New Emphasis on Medico-Physiological Theory
Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. Yet, not one biological marker (“biomarker”) can reliably substantiate a DSM diagnostic category. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly emphasize biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:
•The Definition of a Mental Disorder will include a new statement that a mental disorder “reflects an underlying psychobiological dysfunction.” The new definition implies that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.
•The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) to the new grouping “Neurodevelopmental Disorders” suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for ADHD, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.
•A recent publication by the DSM-5 Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).
Taken together, these proposed changes seem to depart from DSM’s 30-year “atheoretical” stance in favor of a pathophysiological model. We believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to physiological signs or even multiple biomarkers. For example, the increasingly popular antipsychotic medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010).
K. Dayle Jones is a counselor and associate professor at the University of Central Florida. She is chair of the American Counseling Association’s DSM-5 Proposed Revisions Task Force, which was formed to provide feedback to the American Psychiatric Association on proposed revisions to the DSM-5. Contact her at email@example.com