Why DSM is mostly false (2023)
15 days ago
- #diagnosis
- #psychiatry
- #DSM
- The DSM (Diagnostic and Statistical Manual) is often referred to as the 'Bible' of psychiatry, highlighting its cultural and authoritative role, though it struggles to balance scientific validity with its widespread use.
- Originating in 1952, the DSM's early editions had minimal impact due to the psychoanalytic dominance in American psychiatry, which prioritized unconscious conflicts over diagnostic labels.
- Emil Kraepelin's work in the late 19th and early 20th centuries laid the groundwork for modern psychiatric diagnosis by focusing on the course of illness rather than symptoms alone, though his approach lacked effective treatments.
- The shift from psychoanalysis to a more diagnostic approach began in the 1960s-1970s with the advent of psychotropic medications, leading to the neo-Kraepelinian movement and the development of DSM-III.
- DSM-III, published in 1980, marked a significant shift by incorporating Kraepelinian methods but was heavily influenced by political and pragmatic compromises, resulting in many unvalidated diagnoses.
- Subsequent editions (DSM-IV and DSM-5) continued to prioritize pragmatism over scientific rigor, often resisting changes supported by research to maintain clinical utility and professional consensus.
- The DSM-5 faced criticism for its handling of personality disorders, where scientifically supported dimensional models were sidelined in favor of traditional categorical diagnoses.
- The National Institute of Mental Health (NIMH) publicly distanced itself from DSM diagnoses for research purposes, citing their lack of scientific basis.
- Clinicians are advised to use DSM diagnoses for administrative and legal purposes but to rely on scientific research and clinical judgment for actual patient care.
- The DSM system is described as a 'social construction' shaped by professional, economic, and political factors rather than objective scientific evidence.