The Diagnostic and Statistical Manual of Mental Disorders (DSM) is being criticized by researchers for not taking sufficient account of social influences on psychiatric illness and diagnosis.
The American Psychiatric Association (APA) is the developer of the DSM. The new edition, the DSM-5, is scheduled to be released in May of this year. The revision process began in 1999, 5 years after the DSM-IV was published in 1994.
“The DSM-5 revisions are taking place at a time when there is increasing public scrutiny of the accuracy and integrity of psychiatric diagnoses and growing awareness of the role that social and economic influences can play, both in the incidence of disease and in its diagnosis,” contented Helena Hansen, MD, PhD, of New York University in New York City, online in Health Affairs.
“These factors go beyond the reach of biological science and psychiatry and are not adequately accounted for in the understanding of disease currently promoted by the DSM and its revision process.”
Hansen continued by urging, ”Mental health leaders — including those revising the DSM — should go a step further and understand how social and institutional processes shape both the epidemiological distribution of disorders in the population and the way that disorders are identified and labeled.”
Hansen and a group of colleagues, many of whom are researchers in social science and public health, believe that the APA’s limited focus of individual biological factors of mental illness does not adequately inform the clinical diagnostic process.
As an example, the group notes that Social Security payments or access to medications can motivate aggressively seeking diagnoses for individuals or their family members.
Hansen and associates want an ”independent research review body” to oversee future updates to the manual. The review body would ”monitor population-level data on variations in psychiatric diagnosis and coordinate research on the institutional, social, and cultural causes of those variations.” Other responsibilities of the review body would include new research directions and changes to DSM-5, as well as to mediate scientific controversies over “diagnostic patterns and their causes.”
In the past, the DSM has been ”a substantial source of income for the APA,” Hansen’s group states. This could potentially influence the organization’s judgement and therefore, the group contends, ”It thus would be important for the review body to be governed by, and to have its members appointed by, processes independent of the association. This would insulate the review body from pressure to consider the sales potential of the DSM in various mental health provider markets when making future revisions.”