The Diagnostic and Statistical Manual (DSM), version 5, is finally out after years of debate and posturing. This book is considered the “Bible” of psychiatry. It is the one used by all clinicians and doctors to give diagnoses so insurance companies will pay for mental health benefits and so treatment can be directed. It is part science and part art and that can be a problem. For example, in 1968, the DSM voted out Narcissistic Personality Disorder, then in 1980, it was voted back in–not something you see with disease. For example, does bronchitis get voted in and out of disease?
The 947 page manual contains revisions that have been controversial. So much so that The National Institute of Mental Health has turned its back on the DSMV and is working on its own diagnostic system for 2020, claiming to bring more precision to biological markers of mental illness. But DSM V has already attempted that and found it to be more challenging than anticipated. Still, NIMH feels the DSM-V lacks validity and won’t use it in its funded studies.
Even though psychiatry is moving to a more neurobiological model, there is still so much we don’t know. And while we know psychotherapy is effective in so many cases, psychotherapy would be marginalized in a more neurobiological model. Already, it is tough getting reimbursement for helpful therapies like marital and family.
Part of the controversy includes dropping Asperger’s syndrome and child disintegrative disorder. They are included under the blanket autism diagnosis.
Bereavement will now be excluded, making it difficult to distinguish between “normal” grief and depression.
Binge Eating Disorder becomes a full fledge diagnosis that most of us would probably qualify for at some point!
And on it goes…
The reason this manual is so important is because it affects who gets treatment.
What most therapists do is find a diagnosis that seems to fit so people can use the code to pay for their treatment. Then a therapist goes about the business of working with people to solve problems and help them live better. Most therapists will reluctantly embrace the DSMV because of its necessity to service provision. But that doesn’t mean we are excited about the changes.