Boycott DSM5 – it is dangerous and scientically unsound

Sign the online petition to Boycott the DSM5 at http://dsm5response.com/

By Martin Whitely

DSM-5, the newest edition of the American Psychiatric Association’s ‘Bible of Psychiatry’ will be officially released in May 2013 and is already available for presale.  However, this edition of the DSM may not prove as profitable for the American Psychiatric Association (APA) as there is a growing international chorus of voices, many from within mainstream psychiatry, calling for a boycott of the DSM5.

The most prominent critic of DSM5 is Professor Allen Frances who led the development of the current edition DSMIV.  Professor Frances has identified many DSM5 changes that will likely add to ‘the history of psychiatry (which) is littered with fad diagnoses that in retrospect did far more harm than good’.¹

The DSM5 changes Professor Frances is concerned about include:

1. Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder… We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children…
2. Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.
3. The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia…
4. DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.
5. Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder…
6. First time substance abusers will be lumped in definitionally in with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.
7. DSM 5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot.  Watch out for careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets.
8. DSM 5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life.  Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.
9. DSM 5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.²

10. DSM 5 includes a proposal for ‘Somatic Symptom Disorder’ (SSD). This new diagnosis will encourage ‘a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’ and mislabel as mental disorders ‘the normal emotional reactions that people understandably have in response to a medical illness’.³

Professor Frances concerns can’t be dismissed as the architect of the old edition protecting his work from revision. While criticizing the proposals in DSM5, Professor Frances has identified that the DSMIV process he led inadvertently helped ‘trigger three false epidemics. One for Autistic Disorder… another for the childhood diagnosis of Bi-Polar Disorder and the third for the wild over-diagnosis of Attention Deficit Disorder.’⁴ Of course Professor Frances was not solely responsible for the development of the DSMIV diagnostic criteria for ADHD or for other disorders. They were developed by sub-committees of the APA however, as the overall leader of the DSMIV development process he has accepted his share of responsibility for the problems DSMIV helped create.

International Boycotts of DSM5

Internationally there are several alternative online petitions calling for a boycott of DSM5. The most prominent titled ‘Is the DSM5 safe? - Now is the time for mental health professionals and consumers to respond to the problems of the DSM5’ is available at http://dsm5response.com/. Another is titled ‘BOYCOTT DSM5 – Do No Harm’ is primarily aimed at American clinicians and is available at http://boycott5committee.com/.

This second petition has attracted some criticism because it ends with the statement; ‘If we find ourselves obliged to employ diagnostic codes, we agree to disregard the new DSM and utilize the codes listed in the ICD-9 and the next edition of ICD, when the latter is implemented in October, 2014.’ Some DSM5 critics see this as an endorsement of the World Health Organisation’s similarly flawed (but in my view not quite as bad) ICD diagnostic system. I don’t agree. I believe the statement in regards to the ICD is practical advice to American clinicians who are required to quote a ‘diagnostic’ code in order to receive payment from Health Insurers.

In his recent blog, DSM 5 Boycotts and Petitions, Professor Frances suggested there is a real danger that fragmentation and internal differences amongst critics may see the boycott against DSM5 being less effective.⁵ In an ideal world one coordinated DSM5 Boycott approach would be better, however I am not as concerned as Professor Frances about multiple petitions diluting their effect as long as every petition contains the a simple message to: Boycott DSM5 – Don’t Buy It and Don’t Use It – It is dangerous and scientifically unsound.

This is a battle that can be won. Already in large part because of Professor Frances courageous, persistent and effective leadership some of the worst proposals for DSM5 like Psychosis Risk Disorder rolled back.⁶(But unfortunately not yet dead – see Patrick McGorry’s ‘Ultra High Risk of Psychosis’ training DVD fails the common sense test)

Australian Critics of DSM5

Closer to home prominent Australian and New Zealand critics of the DSM5 from within the psychiatric profession include Professor Jon Jureidini, University of Adelaide, Professor David Castle, University of Melbourne; Associate Professor Tim Carey, Flinders University, Australia; Professor John Read, Professor of Clinical Psychology, University of Auckland; Melissa Raven, Research Fellow, Flinders University.

Even Professor Patrick McGorry has been critical of the DSM5 as setting arbitrary boundaries between diagnostic silos.⁷ Professor McGorry argues that ‘Precise definition of the boundary between what is deemed normal and mental disorder with a need for care is difficult. But how crucial or feasible is the creation of such a precise definition? Would a grey area with soft and flexible entry (and exit) and personal choice as key features of a new primary care culture be acceptable?’ While Professor McGorry’s criticisms of DSM5 are valid, the detail of what he proposes as ‘early intervention’ is just as alarming to many within psychiatry concerned about its’ propensity to turn normal human emotions and distress into disease.

Regardless the current immediate battlefront is DSM5. After it is knocked on its’ head then a long overdue national and international debate about the appropriate direction for psychiatric diagnositic systems can begin in earnest.