The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is set to arrive in March. If you aren’t alarmed, you should be.
The DSM is the book from which all our mental health diagnoses come. It’s been with us since 1952 when it had a little over a hundred diagnoses and was virtually unknown. It now offers over five hundred diagnoses that clinicians give out so frequently that 46 percent of American adults and 20 percent of American children and adolescents will receive one in their lifetimes.
The new edition (DSM-5-TR) isn’t getting much press, mainly because the American Psychiatric Association (APA), the private organization that publishes and profits from it, isn’t publicizing it. Why? The previous edition (the DSM-5) sparked a veritable uproar. Criticisms ranged from the authors’ ties to Big Pharma to the way the DSM pathologized normal thoughts, behaviors, and emotions and invented new diagnoses to how criteria were loosened to make disorders easier to diagnose to the fact that political wrangling, not science dictates what is deemed a mental illness.
The foundational problem with DSM diagnoses is that they’re scientifically invalid and largely unreliable and have been called “scientifically meaningless.” None can be objectively proven by a test, x-ray, or other biological marker and they aren’t discrete disease entities. (The only exceptions are dementia and rare chromosomal disorders.) They don’t exist outside a patient’s self-reported symptoms and the clinician diagnosing them. They don’t meet a standard of reliability, i.e., the chances of two clinicians agreeing on the same diagnosis in the same patient are somewhere between a coin toss and zilch.
The DSM-5-TR (TR for text revision) could have been a heroic act. The architects of the DSM could have spent the past decade removing or at the very least reevaluating the DSM’s many, many invalid, unreliable, and suspect diagnoses.
Instead, a new diagnosis was added (prolonged grief disorder, which essentially says that if you grieve for a loved one longer than one year and your grief makes life difficult, you have a mental illness) and the potential addition of suicidal ideation and self-harm as mental disorders. The other diagnoses remain intact.
It’s hard to overemphasize how troubling this should be to us. It means we’re still accepting dubious diagnoses.
To give an example of the kind of diagnosis that remains in the DSM-5-TR, we’ll use binge eating disorder (BED). Given how overeating came to be considered a mental illness, the players involved, the invalidity and unreliability of the diagnosis, and the dangers it poses to unsuspecting patients being diagnosed with it, it’s hard to imagine why the DSM-5-TR didn’t rush to remove it or at least take the time to reconsider it and others like it.
A Diagnosis Is Born
BED started as a theory. In the 1950s, psychiatrist Albert J. Stunkard, a pioneer in obesity research, published a paper on what he called “night-eating syndrome.” This condition was characterized by nocturnal hyperphagia (extreme hunger at night), insomnia (sleeplessness), and morning anorexia (not eating the next morning). It tended to occur during stressful periods and was intricately tied to obesity. All of the participants in Stunkard’s initial study had a weight disorder of some kind.
Twenty-five years later, binge eating made an appearance in the third revision of the DSM (the DSM-III) as a symptom of bulimia nervosa. Those who suffer from bulimia eat, often to excess, and then try to avoid weight gain by vomiting, using laxatives, or exercising. The next revision (DSM-IV) placed binge eating on its own in the catch-all category of Eating Disorder Not Otherwise Specified (EDNOS). The next revision (DSM-5) made it a full-fledged diagnosis.
As with many DSM diagnoses, the criteria decided on for BED is overly general or what’s referred to as “loose,” i.e. easy for people to meet:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances and
- The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).”
Binge eating episodes only need to be “associated” with at least three of the following:
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of being embarrassed by how much one is eating
- feeling disgusted with oneself, depressed, or very guilty after overeating
For a BED diagnosis, a person need only binge on Oreos once a week for three months—on average. You can even skip a week (or two) and still have a mental illness. If a “larger amount” of Oreos is more than three (the serving size listed on the package), you only have to eat five or ten in a two-hour period to feel out of control (Double Stuf, anyone?) and face a binge eating disorder diagnosis.
There are no real parameters. Because body weight isn’t a factor in a bulimia diagnosis, binging is no longer associated with obesity. The diagnosis doesn’t clarify to whom, exactly, “most people” refers. The “similar circumstances” aren’t specified. Many people feel embarrassed eating alone but for reasons that have nothing to do with how many entrees they order. And feelings of pleasure, happiness, and liberation after overeating so much that you have to unbutton your pants seem like inappropriate responses to the situation.
Loose criteria might be justified if the diagnosis could be validated, but it can’t. BED has no validity. The diagnosis is based entirely on what the patient and the clinician perceive as a “larger amount” or “more rapidly than normal” or “uncomfortably full.” Even its core feature of “loss of control” (LOC) has “no clear metrics.” Once given the diagnosis, no objective test can confirm the patient does have the construct called binge eating disorder.
It also has indeterminate reliability. Using DSM diagnostic criteria, two clinicians can’t reliably diagnose it in the same patient. In the DSM-5 field trials, binge eating disorder had a kappa reliability score of .56, falling below the.70 needed to be considered merely “satisfactory.” Raters agreed on the diagnosis only half the time. But “satisfactory” doesn’t mean much in the DSM-5. After field trials produced dismal scores for new diagnoses like BED and even tried-and-true ones like major depressive disorder, the DSM authors fixed the problem by lowering the kappa scores to allow diagnoses with unacceptable reliability ratings to be adopted or retained.
A Diagnosis Is Made
Enter Big Pharma. In 2011, when binge eating disorder was under consideration as an official DSM diagnosis, Shire Pharmaceuticals had already sought to market its drug Vyvanse, an amphetamine, as the only drug available to treat the disorder. With a 6.9% prevalence rate in the United States, a DSM diagnosis would create at least 21 million potential new customers and bring in an estimated to bring in $200 or $300 million to the company annually.
Vyvanse became the official BED medication because there was a DSM diagnosis of BED. The FDA seemed not to mind that it hadn’t been proven as an effective treatment for binge eating disorder beyond its appetite-suppressing properties. A spokesperson for the Food and Drug Administration (FDA) said the drug was approved simply because there was no other medication to treat the newly minted binge eating disorder.
(Before Vyvanse, the “treatments of choice” for those who binged were psychological therapies: Cognitive Behavioral Therapy and Interpersonal psychotherapy—neither of which made money for big pharma. Other drugs had been tried: stimulants, antidepressants, and anti-seizure drugs, but many of those had lost their patents, i.e., drug companies were no longer cashing. None was terribly effective at treating binge eating disorder.)
To take full advantage of the situation, Shire launched a disease awareness campaign. The company didn’t advertise the drug Vyvanse; it marketed the diagnosis BED. It partnered with patient advocacy groups like the Binge Eating Disorder Association and the National Eating Disorder Association (NEDA), which, ironically, sponsors this week’s eating disorders awareness campaign to supposedly “educate the public about the realities of eating disorders” without, of course, disclosing its ties to Big Pharma. In turn, NEDA helped flood the internet with personal stories of binge eating.
It ran an advertisement featuring tennis star Monica Seles, “the face” of BED. The ad falsely claimed that BED was the result of a chemical imbalance. Shire urged consumers to self-diagnose based on a DSM symptom list and to talk to their doctors, presumably to get the diagnosis and a prescription for Vyvanse, both of which will be determined by the patient’s self-reported symptoms based on the DSM’s subjective symptom lists and the doctor’s opinion.
BED has since become the most commonly diagnosed eating disorder. We can attribute that in part to pharma but without the DSM, there would be no diagnosis for the FDA to approve.
Defenders of the DSM argue that diagnosis will help counter the obesity epidemic but pathologizing overeating acts as a scapegoat for the real problems in our society. It’s not surprising that 4 in 5 of us regularly overeat. Given our highly processed foods, enormous portion sizes, and limited fresh foods in low-income areas, binge eating seems practically inevitable. Junk food is designed to be binged on. An Oreo acts on the human reward system, not unlike the way heroin does. As Michael Moss, author of Salt Sugar Fat and Hooked, and others have shown, food giants like Nestle, Coca-Cola, and General Mills engineer foods not just to make them delicious but addictive. We’re targeted by advertising campaigns for fast food, sugary drinks, candy, and unhealthy snacks. Celebrities get paid millions to influence us to buy the most unhealthy options. Overeating typically results from stress, and we’re some of the most stressed-out people in the world. For those with economic means, food is plentiful and can be delivered to our doors.
BED is just one of the diagnoses we’ll continue to receive as a result of the APA’s failure to correct the mistakes of DSMs past. We’re left with diagnoses designed to be easily given out, accepted, and identified with. As psychiatrist Michael First and scholar Jerome Wakefield put it, “virtually every psychiatric symptom characteristic of a DSM disorder can occur under some circumstances in a normally functioning person.” When the DSM-5-TR arrives in March, it should be seen for what it is—a missed opportunity to improve mental health care where it begins: the DSM.
Thank you.
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thank you for sharing
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Let’s hope they run out of acronyms soon.
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There are 419,450,149,241,406,000,000,000,000 (or 419 Octlillian) combinations of potential acronyms in the English alphabet.
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wouldn’t there be infinite? you could put an endless amount of letters in an acronym
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Call it for what it is. Its the fucking governments fucking aide to expedite the 1984 fucking machine to create the Superstate. How could we question Big Brother if over half of us (the 48% mentioned in the article) are “mentally ill?” Its easy to install with quantum computing as well as political lockdowns only further fostered with more totalitarian agendas seen in the Left and exacerbated with endless crises stemming from our collapsing civilization. The End.
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Removed for moderation.
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Big corporations will literally drive their customers into the grave if it makes them money; there needs to be pushback against their domination of society’s rules and Big Pharma in particular (take your pick).
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From library, just picked up Allen Frances’ book, Saving Normal An Insiders Revolt Against Out-of-Control psychiatrics diagnoses, DSM 5, Big Pharma, and the Medicalization of Normal Life, from 2013.
It was too late then, he’d already contributed to the ruin of what, millions? Plus I saw the guy waffle on PBS, in 2021.
2013 was too late for me. Worse-than-religion-psychiatry already ended my life except for the torture.
Groundhogs Day. Life after psychiatrics crime is never ending hell. Nothing is worth this hell. Not another minute, day, or Feb 2. Oh god the horror please no more.
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It hardly matters what changes are in the DSM-5-TR. Whatever is there will be vastly overdiagnosed and overtreated because few clinicians can actually distinguish the conditions it describes.
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Actually, there is no way to judge “overdiagnosis,” because with the utter subjectivity of EVERY DSM “diagnosis,” there is no way to determine what the “correct” level of diagnosis really is. So how can you “overdiagnose?” That’s part of the brilliance of the DSM – you can’t tell the they’re wrong, because there’s no way to prove it!
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Perhaps they should make an Un-DSM.
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“Whatever is [in the DSM-5-TR] will be vastly overdiagnosed and overtreated because few clinicians can actually distinguish the conditions it describes.”
And even fewer clinicians claim to garner insight into, or actually understand, the common adverse reactions and withdrawal symptoms of the psych drugs. Don’t you agree, Altostrata?
“That’s part of the brilliance of the DSM – you can’t tell the[m] they’re wrong, because there’s no way to prove it!”
That’s called a “Catch 22,” and everyone – except apparently psychiatry, and other criminals – knows “Catch 22’s” are unethical. So are you saying being unethical is “brilliance,” Steve? I doubt it. So let’s call the psychiatric industry out for whom they actually chose to become.
And I will disagree, to some extent, that we here “can’t tell the[m] they’re wrong, because there’s no way to prove it!”
Since we here have already pointed out that the ADHD drugs and antidepressants can create the “bipolar” symptoms. And we here at MiA have also pointed out that the antipsychotics can create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome. Plus, we here at MiA have also pointed out that the antipsychotics / neuroleptics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.
So we here at MiA have already pointed out the medical proof of the iatrogenic – not “genetic” – etiology of the two “most serious” DSM “mental illnesses.”
And since the psychiatrists have zero proof that any of their “invalid” DSM disorders have a “genetic” etiology, nor any other biological cause. And their “chemical imbalance” theory was debunked “by serious psychiatrists” decades ago.
The bottom line is we here can say the primary etiology of the two “most serious” DSM “disorders” is likely iatrogenesis – not some elusive, medically “invalid,” unproven “genetic” DSM disorder. Since we know the psych drugs are medically known to create the symptoms of both “bipolar” and “schizophrenia.”
And I’m not sure of a much better way to disprove the psychiatrists’ DSM theology, than to medically prove their drugs literally create their two “most serious” DSM disorders.
But, I’ll bow to Altostrata to point out more of the problems with the depression diagnosis, and it’s treatments.
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Thank you, Sarah, for this informative post.
What if every single diagnosis in the DSM has either been simply made up by the experts on its committees based on their subjective hunches or pressured to be created by special interests like BED? What if none of them has ever had any validity despite decades of frantic searching funded by billions of dollars? What if the DSM framers themselves readily admit this?
What should we do with the DSM? Pretend its diagnoses are valid and place it at the center of every aspect of the system including education, assessment, intervention, access to services, and the legal system? Ok, makes sense, will do.
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Brett, the DSM is BEST SEEN as a catalog of billing codes. EVERYTHING in it was either INVENTED, or else CREATED, and NOTHING in it was “Discovered”. Thus, the DSM is FALSIFIED, and renedered the bogus sham & scam which it is. All of psychiatry is a pseudoscience drug racket & social control mechanism, so why should the DSM be any more “real”?….It’s all Ph.D.-level Bullshit….
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DSM-5 TR. “Text Revision”. Official title. Only means they tweaked some text, added a few more lines from the marketing folks. Nothing much changes in the “new” DSM-5 TR…. So why bemoan that it doesn’t? Let’s remember, NOTHING in the DSM was discovered, it was ALL either invented, or created! Think about the not-so-subtle, and crucially vital difference! The Gov’t, PhRMA, the APA/DSM-5 TR, Media, all conspire to pump neuro-toxins into the mass of the American people. For profit. Their profit, not ours! Sadly, most of us, – present company perhaps excluded, – seem just fine with the situation. Sad, very sad….
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BPD DX at Yale following ECT was what they called help—drugging me, blaming me, lying to and about me. It destroyed my physical and mental health, killed by hope, and now this:
https://medicine.yale.edu/psychiatry/bpdconference/
They’re going to bring a bunch of experts together to study why borderlines engage in disruptive behavior.
Like substance abuse, you know the thing that have the population does. But when borderlines do it let’s come together and and talk about it because it’s fascinating and we need to study it. I wonder if they’ll have a panel about disruptive behavior and response to abuse from treatment providers, and response to being labeled and poisoned based on lies.
The whole society is insane that they allow these “experts” so much power.
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I’m waiting for the conference on how big pharma, psychiatry and DBT collude to abuse, scapegoat and otherwise gaslight vulnerable people. They never want to talk about their own behavior.
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Nobody pays them to….
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There’s also how after, for example, Columbine, one couldn’t even be distressed regarding what should have been known (see Mark Taylor… no that ISN’T Any Taylor the gay porn star who reincarnated from allowing Dizz-knee to put his beautiful story Bambi on film, I think a book that most of us in childhood read and were brought to tears, I know I did; and after-thoughts of vaulted spaces I wasn’t accustomed with enough to be comfortable with unless brought to tears, but heh know it would be an add for antidepressants with the book, a commercial for them when shown on TV and a whole array of pumped up solicitations coming your way did that not assault your senses with their “art.”)…
No that wasn’t Andy, that was Mark Taylor https://www.youtube.com/watch?v=YCO0AN8PJmA
Who was put in a foster care, forced drugged till he couldn’t detail what should be known, after asking whether they had sold any of this book at a local bookstore, and then thought he could relax by pacing at the mall: https://www.amazon.com/Asked-God-Answered-Columbine-Miracle/dp/1598863495/ref=sr_1_1?crid=1VQWRGX6I8N50&keywords=i asked god answered mark taylor&qid=1644078918&sprefix=i aksed god answered mark taylor,aps,404&sr=8-1
And the bullet he had that the medical establishment couldn’t remove did go into the spheres of forgiveness [disappeared] when he visited a place Christian enough that it is something else one can’t talk about..
And then to top it off, one even has this CONTINUATION of institutional abuse with one woman whose son was a perpetrator, and who I was told by someone with a foster care facility in that area, came there to talk because he had been bullied by jocks, had been told to go to the Sheriff, who told him to go back to the principle of the school, etc. It wasn’t acknowledged, there’s signs he was raped by a police man; and when his “medications” were changed to Luvox, he told his doctor that he was having homicidal thoughts towards everyone: his family, his friend, his girlfriend…..
THAT would have been exposed, but the drug companies bought up that case against them, and then you have this absolutely pathetic disgusting further abuse, institutional abuse, corruption, deception, by his mother https://www.youtube.com/watch?v=BXlnrFpCu0c
More than ten million views and comments are turned off…..
While defending the major cause of the horrible incident, and getting away with it, the drug companies continue with more lies……
She does a TED talk https://www.ted.com/talks/sue_klebold_my_son_was_a_columbine_shooter_this_is_my_story?language=en
She has a WIKI page https://en.wikipedia.org/wiki/Sue_Klebold
And for example, there’s a whole list of healers, that work with the same energies that removed Mark Taylor’s bullet, that spared him, that would have prevented the whole incident, and they aren’t acknowledged at all. Have no Wiki page.
Michael Stellitano, Charlie Goldsmith, Gene Egidio, Brother Gregorio, Father Joshua philipino healer same as Gregorio, Leaholof (was Jesus mother his prior incarnation as Manasseh son of Joseph the dreamer),
Ask the Royal Family (William and them) they know about these people, they don’t mention them.
All I did one day is play with my own memory, wondering whether Prince William with Chekhov was playing around making explicit material in a bomb shelter of a Meijer store (that’s all I could make out of the possible surveillance at self checkout, where it asks if your basket is empty); when while sitting and delicately separating the layers of knapkins or other papers used for drying one gets “everywhere” and I keep in a pocket for later use after once having fallen for it to then find out you can draw on them or paint or whatever, dip it in wax and it looks like parchment: so I’m doing that, separating layers, and I’m met with a Sherrif [again] and partner regarding that I was acting “weird” (I knew they didn’t really have a bomb shelter actually, I just asked to see how they would respond) had asked whether they had a bomb shelter and they were concerned about mass shootings.
I gave them my phone [number] so they could listen to me tell “Thomas” how I didn’t really like that Yanni looking thing in the box, but liked the box (it was pizza), who would be Thomas Linley (Taylor Lautner) who has fallen in love with me, and has patiently waited for more than 300 [years]…. the poor Sherrif (who in his free time started that whole scene with Tim Skyler as snow white missing a dwarf for TIM gay porn) he had to tell me that he had a conditioned response when I went for the ID, which he did for his own safety. I can be thankful HE wasn’t an antidepressants. As he then kept asking me so many times whether I was leaving, I knew they had to being drilled on that (as if I still was going to who knows what) as well; and then remarked how full by bag was (I would have not neglected to tell them they could look all through it as much as they wanted, but already was holding back regarding anything about drugs and mass shootings)…
As the Muzak played on, and I still can’t type here without incredibly distracting noises, like cars coming by droning the insensitivity of those using the wheels….
But heh, I’m sure Madame Klebold still has her nice [quiet] suburrbion house, gets published as soon as it comes off her placidly FDA intelligensia fingers, while smiling and feeling self important as soon as someone else wants to believe in her lies and doesn’t ask why the drug companies haven’t reported what kind of assault they accomplished on her son, who is fortunately out of the picture having to deal with such a person that still calls herself the mother of someone who committed suicide how many years ago, because he was “raised” by her!?
Oh, and I did find out where Chekhov is….
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Oh the suspense…
But I am a little curious, per- Philip Hickey’s penultimate blog, Addressing The Social Determinants of Mental Health, if complex PTSD ( especially as developmental trauma) will find it’s way into this redux ad nauseum. If memory serves, Bessel van der Kolk-and others- tried to no avail get it included in DSM V. My curiosity about this revolves mostly around APA President Pender’s assertions surrounding a (my words to sum) more inclusive consideration of the social determents upon their “customers mental health”. My curiosity here runs somewhat parallel to Senator Minchin’s final position on BBB; which is to say that I saw this outcome (and wrote as much) in July. Still…every once and a while its refreshing when scoundrels’ deliver some semblance of their words, or remotely deliver in the spirit of their institutions raison d’être. Failing that, I hope, at least, that this is the inaugural graphic edition, complete with action packed color dramatizations of psychiatrist saving their customers one DSM VI diagnostic frame after another.
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It is fascinating how the arrogance and corruption of these “leaders” are there right out in public for anyone to see, and yet so few see them. “Consideration” of the social determinants? As if THEY are in the position of deciding what is true, rather than observing the known facts? And their “customers’ mental health” – are we admitting here that the APA is a trade marketing organization that doesn’t give a crap about science as long as they maintain their market share? And why would a professional want to come and beg these folks to include something in their manual when it’s obvious that they don’t give a half a crap about the patients’ “social determinants” as long as they’re making sufficient profits?
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There’s no reason to fear the DSM or any other aspect of psychiatry. Just stay away from them — would you deliberately shake a hornets’ nest?
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Psychiatry and its DSM have changed the fabric of society. It’s impossible to escape them.
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There is only one Bible and it’s Holy and it sure isn’t the DSM or any book that thinks it is a bible. Thank you.
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This is a concerning development.
What perhaps needs to be researched and discussed is: why do many people (patients, parents, teachers, courts/lawyers, the medical profession and politicians) seek out and/or comply with or otherwise accept – DSM diagnoses?
Are there incentives?
Do the incentives differ, for different groups of people?
Is it time to focus on uncovering all incentives, both conscious and potentially unconscious?
Thank you for this article post.
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Good one
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Probably the same reasons people fall for other scams.
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Mental health is a real concern in America and DSM diagnoses are often the only way to receive insurance coverage for services. I understand the point of this article is that it’s too easy to misdiagnose or overdiagnose. But objective measures in psychiatry are difficult to come by bar the aforementioned dementia and chromosomal disorders, as well as intellectual disability and a couple of other developmental disorders that can be seen on fEEG or with cognitive testing and I’m sure a couple of others. Genetics is likely going to help us with making more objective diagnoses in the near future, but behavioral/ psychiatric genetics lags behind other areas of genetics just like many other areas of psychiatry. Psychiatric illness is intagible and therefore more difficult for many to conceptualize. So while I understand the writer’s perspective and there is certainly some truth to it, I believe it to be from a place of privilege. If you believe you can make more objective diagnostic practices while still getting people the help they need utilizing the resources currently available, please have at it. Unless you’re arguing that psychiatric illness is a figment of the imagination, in which case I cannot help you.
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I think you are overlooking a rather obvious point – the manifestations called “diagnoses” in the DSM, however real the suffering involved, are assumed to be (even by you) some sort of physiological experience. Hence, if the person’s brain were “right,” they would not be depressed, anxious, intense, or whatever. This is an absolutely nonsensical assumption! These “illnesses” are “intangible” because they don’t actually represent physiological illnesses at all. These diagnoses represent a potpourri of different emotions and behavior that are literally VOTED into or out of existence. The emotions and behaviors so designated are all things that occur with some frequency in “normal” people, and the “criteria” are very much arbitrary distinctions between “normal” and “abnormal,” which the DSM itself admits in the introduction are not able to distinguish groups of people having actual problems in common with each other.
https://www.psychologytoday.com/us/blog/in-control/201908/mental-health-diagnosis-just-say-no
“One of these innovations was that the new DSM was “a descriptive approach that attempted to be neutral with respect to theories of etiology” (p. xxvi). So, even though diagnosis is the identification of the nature and cause of a phenomenon, the APA somehow reconciled publishing a diagnostic manual that made no reference to the cause of that which was being diagnosed.”
[Direct quote from the DSM:] “In DSM-IV, there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or no mental disorder.” (APA, 2000, p. xxxi). So, the categories that DSM offers us do not have boundaries demarcating one disorder from another or, indeed, one disorder from no disorder. This is an extraordinary revelation. This means, according to the DSM, there is no assumption that the category “schizophrenia” has boundaries that separate it from other mental disorders or from not having schizophrenia.”
In other words, the distinctions in DSM diagnoses are ARBITRARY, they are not based on any legitimate grouping of people who have a problem in common.
Take “Major depression” for example: It COULD be caused by physiological events, such as drug side effects, low thyroid, anemia, Lyme disease, brain tumors, etc. It could be caused by social events: death/loss, current abusive relationship, unemployment, neighborhood violence, racism or other discrimination, being stuck in a dead-end job, poverty, etc. It could have psychological causes, such as a particular attitude toward life and events, high stress, prior abuse/trauma history… you get the idea. It is just SILLY to think that a person who is depressed because his mother died when he was 17 and he’s feeling a deep sense of loss has the same needs/problems as a person who is currently being abused by her partner, or has the same needs/problems as a person who was just diagnosed with cancer and is having side effects from chemotherapy. These people CLEARLY do not fit into the same category for either study or for planning, and yet the DSM makes absolutely no distinction between these groupings – these people, if they meet the criteria, are “diagnosed” with “major depressive disorder,” regardless of the cause or what their actual needs of the moment are.
Now I’m not saying that individual practitioners don’t make these finer distinctions. I hope that most of them do. But the DSM itself is useless as a “diagnostic” manual if it can’t distinguish between a cancer patient taking drugs that affect the mind (not to mention having a big existential problem regarding their prospective death), and a person whose mother just died and a person who has a malfunctioning thyroid.
That is what people mean when they say “mental heath diagnoses are not real.” They’re not saying that people don’t experience depression or anxiety at sometimes severe levels. They’re saying that the DSM “diagnoses” are of no value in establishing either cause or optimum “treatment” or prognosis. They are scientifically meaningless labels that are at best useless except to bill an insurance company, and at worst can be extremely destructive by papering over the real issues involved and invalidating the knowledge and experience of the client.
Given all that, I very much doubt that a “more objective diagnostic system” can ever be achieved, because the very idea that people who have difficulties emotionally or behaviorally are medically “ill” is absolutely without basis in reality. There may be a very small subset of these conditions that can be attributed to actual medical problems, and they should be, but calling everyone who finds life pointless at a particular moment “ill” as if someone whose mom just died is supposed to be cheerful is an absurdity that is not redeemable except by scrapping that concept and starting over.
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Just to add a little extra evidence, I looked up “causes of depression” on Google. Here is a list of the titles that turned up:
The 4 major causes of depression
The 7 major causes of depression
3 major causes of depression
The 8 forms of depression
The #1 cause of depression (Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged work stress – are more likely to cause depression than recent life stresses.)
That’s on one search. Doesn’t sound like anyone has a grip on what “causes” depression, and there are as many theories as their are people tossing the label around. I think it’s because depression isn’t a “thing” that has one “cause.” It is an EXPERIENCE that can have hundreds of potential causes, and depending how it is handled, can lead to deterioration or to the opening of new perspectives on possible interventions that may improve one’s life. Any attempt to try and come up with one “diagnosis” for such a varied and nuanced experience is doomed to failure.
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Thank you for this educated response, I came to try and find out the release of the DSM – 6 and ended up having to digest a lot of nonsense. This article is infuriating for those of us that have and have studies mental illness and disorder. No scientist will ever present information saying it is the end all be all. If it’s wasn’t for the DSM many of us would still be struggling.
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The only thing that is right in your post is that the DSM is used in health insurance in determining pay-outs to doctor and reimbursement, etc. to the patient. Any genetic basis for any alleged psychiatric disorders has so far been categorically unproven and this has been written up on this website. Yes, mental health has become a concern only because mass media in conjunction with the mental illness industry has worked with big pharma to create this need. In my opinion, psychiatric illnesses are really the work of overworked imaginations for profit and other illegitimate gains. Most of what allegedly “passes” as something in need of a mental illness diagnosis as allegedly described in the DSM is just hyperbole of normal human emotions and the normal human condition in response to life and its myriad of changes and also the tragic things that can happen to someone in life in which case, the responses are normal of someone who is human. I am not for burning books, so I in gratitude to those who wrote these DSM books for a fascinating fiction read. But there is one thing about this fascinating fiction read that I should never ever forget and that is the damage and suffering it has caused so many it didn’t deserve it because they were only being their natural human unique selves. Thank you.
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I absolutely believe that we need a better system than the DSM. I disagree on the stance that it does more harm than good. We need better, however the field of psychiatry, as I said before, lags behind nearly all other fields of medicine and stances like this don’t help that.
The idea that psychiatric illness doesn’t have physiological process is a little archaic. There are neurotransmitters, hormones, genetics, epigenetics, individual brain development, head trauma, etc. involved in things like depression. The research isn’t as advanced as, say, cardiovascular medicine, but that’s for the same reasons I mentioned before. Mental health research has always been a low funding priority. Just because we don’t understand the process of some diagnoses, doesn’t mean they don’t exist. People need means to acquire treatment & accommodations and the DSM provides the only current avenue for that. As you’ve said, you shouldn’t expect a persons who’s mom just died to be cheerful. Fair. But that doesn’t mean that person couldn’t benefit from mental health services to get to their new “normal” quicker and reduce overall suffering (e.g. to help them stay employed). As you said, we expect practitioners to apply discretion when making these diagnoses.
P.S. your google search isn’t evidence. Try google scholar. Those are clickbait articles oversimplifying research.
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Again, I think you miss my point completely. It is not scientific to ASSUME that a cluster of behavior/emotion/thoughts that tend to occur together are a “diagnosis” that is caused by something biological. You are taking a PHILOSOPHICAL position, called Materialism, in assuming that there is no other possible cause. What EVIDENCE is there that any two cases of “depression” have or need to have a common cause? I already gave you a half a dozen reasons why a person might be feeling despairingly hopeless. Are you really suggesting that a person who is depressed because they feel trapped in a domestic abuse situation should have the SAME DIAGNOSIS as someone who is depressed because they are suffering from a low thyroid situation or Lyme Disease or a head injury? Do these cases have ANYTHING in common other than the similarity of emotional reaction? Would any sane person prescribe the same “treatment” for all four situations? If you gave antidepressants to a person in a DV situation, and they suddenly felt more comfortable being abused by their partner, could you consider that a good result? Are there times when feeling anxious and/or depressed is a NECESSARY, NATURAL process that helps humans decide to alter non-optimum living or social situations?
I am certainly not asserting that there are not biological correlates to the actions/experiences of the mind. For instance, we know that Buddhist monks who meditate regularly actually CHANGE THE SIZE OF PARTS OF THEIR BRAINS. But consider what that means – their CHOICE of mental activity alters the physical structure of their brains. So how can we assume that the brain is entirely causing their mind’s actions if their mind can alter the structure of the very brain it is supposed to be created by? Clearly, there is something far more complex going on here. Is the “biology” of depression (which btw has never been found to consistently exist for depressed people) the CAUSE of a person being depressed, or is it the RESULT of their framing of events as hopeless? If the mind is just a function of the brain, how is it that ASSUMING A DIFFERENT VIEWPOINT can “cure” depression or anxiety without any physiological intervention whatsoever?
It is incredibly simplistic to believe that there will EVER be a simple, scientific, objective, biological explanation for why people get depressed, because the number of variables is ENORMOUS, including the direct impact of the MIND on the BRAIN. Of course, being a materialist, you no doubt reject my premise that the mind can transcend the brain and act upon it, but that is again a philosophical and not a scientific position. You can provide no proof that people who meet the criteria for “Major Depression” have anything in common at all, and the DSM itself admits that the “diagnosis” does not lead one to that conclusion. So what’s the point of grouping those who feel depressed together at all? Wouldn’t it make a lot more sense to group together people who have domestic abuse histories with others who do, even if some are angry, some are depressed, some are anxious, and some are feeling pretty objective about the situation? But of course, being a “domestic abuse survivor” will also never be a biological “diagnosis,” because it’s not a biological condition. It’s a social one.
I hope I make myself clear.
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This article is very poorly done, and the writer does not have the appropriate psychological knowledge and training to be speaking to people about these things.
Please read the DSM-5-TR for yourself to come to a better understanding about its appropriate use.
Certainly, people who should not have the authority to diagnose disorders have used the DSM for nefarious purposes, but as a work, the DSM itself is not a nefarious work.
A couple sentences under “Use of the Manual” say the following:
(from the DSM-5, not from DSM-5-TR because all I have available at the moment is the DSM-5):
“The symptoms in our diagnostic criteria are part of the relatively limited repertoire of human emotional responses to internal and external stresses that are generally maintained in a homeostatic balance without a disruption in normal functioning. It requires clinical training to recognize when the combination of predisposing, precipitating, perpetuating, and protective factors has resulted in a psychopathological condition in which physical signs and symptoms exceed normal ranges.”
To translate, this means that the symptoms under each disorder are things that yes, do occur in the average person’s life. Therefore, it takes great practice (and mentoring from other psychological/medical professionals) to be able to properly recognize when a disorder is occurring and not just an average behavior.
As a tool for the diagnosis of mental disorders, from my point of view, the DSM is not inherently a nefarious tool for the financial gain of “Big Pharma.”
Again, the text is certainly unfortunately used for that at times, but that does not appear to be the intention of the text in and of itself.
The text is helpful for the sake of categorizing psychological symptoms so that better research and treatment may be done. The DSM is not to be used to treat a disorder, but rather it says, “recommendations for the selection and use of the most appropriate evidence-based treatment options for each disorder are beyond the scope of this manual.” Again, the DSM serves to categorize mental disorders as sets of symptoms commonly experienced together and probably related to one another. The DSM may be helpful, for example, in the case of experimental research being done to test the efficacy of certain treatments for disorders. If researchers are able to categorize subjects as suffering from bipolar disorder, for instance, then they may be able to conclude that one treatment over another may be better overall for those suffering from the disorder. Of course, the researchers recognize that treatment is not totally scientific. It’s never a mathematic equation of “These symptoms mean we need this exact treatment which means we will get this exact result.” I think many would agree that that thought would be much too idealistic. Every person is different, and yes, there are probably different causes of various disorders, and some of them might indeed be simply due to behavioral conditioning or social role-playing or something. But, again, if a treatment is shown to be effective (clinically proven), then it may be chosen to try to treat a patient over another treatment that has not shown to be as effective.
By the way, for those who do not know, medication is not the only treatment option for these disorders. Cognitive-behavioral therapy, for example, has been shown to be effective for mood disorders. Some receiving treatment for depression through cognitive-behavioral therapy also take medication to help manage their symptoms, and that may help as well.
There are many different perspectives about how and why exactly disorders occur from biological theories to behavior theories to social theories. The DSM’s role is not to promote one perspective on the disorders over another. The DSM’s role is simply to be a medical tool for diagnosis of disorders. Diagnosis can then lead to treatment or to more research.
The DSM is a helpful tool.
Some of you have said that genetic factors have been proven to not affect the rates of mental disorders, but that is just false. Monozygotic and dizygotic twins have been shown to have higher rates of developing the same mental disorders, and those with a first-degree relative with a mental disorder have also statistically been shown to be more likely to have the disorder. Yes, there are certainly, without any doubt other factors that contribute to having a disorder or not having a disorder, but genetic factors do contribute.
By the way, I am in complete agreement that there is a big problem with direct-to-consumer pharmaceutical marketing which is what occurred featuring Monica Seles. Treatment options should be discussed between a medical/psychological professional and a patient. The medical/psychological professional should know the treatment options for whatever is going on, and they also know what medications may be appropriate for the patient. And I am sure that most professionals in these positions have the patient’s best interest at heart because their jobs are incredibly difficult and exhausting and strenuous, so many are in those positions because of a great desire to be of service to people. Therefore, I think that is best to leave recommendations of treatment for those in these positions, and I think that direct-to-consumer pharmaceutical marketing ought to be illegal because of the issues it often causes.
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After bloodwork and physical symptoms indicating chronic inflammation, I went gluten, dairy, and (mostly) sugar free.
While this helped to a degree, my longtime elimination of the heroine-like junk food the author writes about didn’t stop my binge symptoms entirely. Yes, that helped, but I absolutely still get mad, impulsive cravings to eat.
No, this isn’t stress related. It’s potentially sensory related, however. It’s maybe a sensory-seeking behavior for me and my mind fixates on it. I’m late-diagnosed as autistic and ADHD.
To shame people who struggle with binge eating by insinuating BED was made up and purposely easy to diagnose for selling a drug is off base.
This is an instance of someone who doesn’t have lived experience speaking over/for people who do.
I started Adzenys and an afternoon Adderall tablet boost for ADHD-specific symptoms and, surprisingly, they eliminated my binge-eating tendencies. I noticed after a couple of months and it felt like a gift. It was NOT appetite suppression. This is different.
Then going off of those, my symptoms came right back. I had to go off of them due to a facial flushing/rash I developed from the amphetamine salts after 7 months.
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Removed for moderation.
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No one in this thread has billed insurance and it shows.
You want your therapist (or their assistant) to bill your insurance and have it paid? You must be diagnosed with something. You can’t have therapy for the sake of therapy unless you pay *cash*. Your insurance NEEDS there to be something wrong with you in order to pay your bill. Is it fair? No. Insurance in this country is nonsensical and it’s a predator.
This does not mean that everyone grieving a loved one for longer than a year is mentally ill. it means if you are going to therapy and the therapy is because you are sad and grieving, they must call it “prolonged grief” so that your insurance pays your bill. That’s all the DSM exists for. Billing purposes. Oh, and sometimes to charge criminals, but mostly for insurance.
If you’re mad about the DSM, take that up with the insurance companies and the government that requires us to have insurance. If insurance companies would just pay bills based on “I spent an hour talking to this person because they needed it” the DSM would not exist.
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I’m aware that it’s beyond useless to comment on an article from two years ago. It is even more useless to make corrections to this kind of under-researched “reporting” that serves only to fearmonger about psychology and “wokeism” and that no one here believes that the DSM serves any purpose beyond the conspiracies they’ve concocted. But I do think that it needs to be said: It is standard practice to release a fully revised edition of the DSM every 20 or so years. (We are currently on the 5th edition, aka DSM-V.) In between these major overhauls are smaller revisions every 5 to 10 years. This has been standard practice since at least the 1974 printing of the DSM-II. The DSM-V-TR that this article was so afraid of is one of these smaller revisions. (Which is why it was not widely discussed. It was not a major overhaul of the existing material.)
This is a good thing – research is constantly happening in EVERY scientific field, including psychology. We know new things about the brain that we didn’t when the DSM-I was written in the 1950s; we know things about the brain that we didn’t know when the current edition was released in 2013! I have certainly known of instances where a bad doctor warped or misread diagnostic criteria in a way which led to an inaccurate or even harmful diagnosis… but I’ve experienced that with other kinds of doctors as well, so it is certainly not a DSM or psychology-exclusive problem. (And the way that I’ve seen it occur is not in the way that many of you probably expect based on your biases.) But acting as though this was some insane or diabolical move is ridiculous, and disregarding the legitimacy of the DSM as a diagnostic tool is at best foolhardy and at worst dangerous.
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