Three Reasons Why I’m Not Looking Forward to a DSM 5

  1. The absence of clear biological markers to aid us in establishing an etiological basis for diagnosing mental health disorders will translate into a manual that is more of the same. Lacking such markers, lists of symptoms will continue to be grouped into syndromes that are different in name only.
  2. The manual is not an improvement over the current DSM-IV and offers no clear advantage to the user. This edition has taken its sweet time getting itself together, and from what I’ve read, along with my own investigation, does not markedly set itself apart as a body of work with unique characteristics. Criteria will still be loosely defined. Symptomatic overlap among co-morbid conditions will continue to make them indistinguishable from the primary diagnosis. This book will expand the “what” while continuing to ignore the “how.” A ground breaking step would be to add a section that provides a set of guidelines with steps for how to make a diagnosis. The inexperienced, novice clinician without a number of clinical exposures under his or her belt could benefit significantly from this addition.
  3. A third reason is that diagnosis is a snapshot in time. It may be accurate at the time it was made yet it is also static. The next frame in a series of diagnostic “photos” may differ from its predecessor, showing a different picture. Why? Because people’s experiences and defenses shape their adaptability over time. A client diagnosed with depression today, may have been diagnosed with generalized anxiety disorder by another practitioner some time ago. This is not a matter of who’s right or wrong; possibly both clinicians correctly diagnosed the client as he/she was at that time. The fluid nature of diagnosis has been an issue with previous DSMs as well, but with DSM-5’s decision to increase the overall number of diagnosable conditions, there’s a cause for consternation. Clinicians don’t need more diagnostic “photos;” they need better quality “photos” so as to be able to differentiate appropriately.

 

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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