DSM-5: SOCIAL, POLITICAL, AND ETHICAL IMPLICATIONS

Julie R. Ancis, Ph.D.

(c) Julie R. Ancis

SOCIAL/POLITICAL CONTEXT OF DSM

Considered scientific, thought to rely on well designed, executed, & accurately interpreted research. Used by HMOs, hospitals, clinics, insurance companies. DSM categories used in civil & criminal courts. Foundation upon which US Congress based their proposals for mental health parity in insurance plans.
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SOCIAL/POLITICAL CONTEXT OF DSM

Sales of DSM & related books, CD-ROMS, videos, audiocassettes, casebooks a multimillion dollar business.

Pharmaceutical Companies driving and promoting diagnoses.

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GENESIS
DSM DSM DSM DSM DSM DSM DSM first published in 1952 II 1968 III 1980 III-R 1987 IV 1994 IV-Text Revision 2000 V-Scheduled for release in May, 2013

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ADDITION OF DIMENSIONAL ASSESSMENT

Rationale: Question about whether DSM -defined disorders represent discrete entities (Yes -No) versus dimensions that exist along continuous distributions.

Problem of comorbidity/co -occurring disorders, boundaries, & excessive use of NOS categories.
Dimensional approach
Rating scales to measure severity, intensity, frequency, duration of given DSM categories.

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ABUSE AND ADDICTIONS

Substance Abuse & Substance Dependence replaced with Substance Use Disorder . Severity Levels - Mild, Moderate or Severe. Internet Use Disorder currently proposed for inclusion in Section 3, an area of DSM-5 for conditions requiring further study before considered disorder.

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DSM V CRITICISM
Dr. Allen Frances former chair of DSM-IV Task Force. May 11 , 2102 New York Times Until now, the American Psychiatric Association seemed the entity best equipped to monitor the diagnostic system. Unfortunately, this is no longer true. D.S.M. -5 promises to be a disaster even after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription. The association has been largely deaf to the widespread criticism of D.S.M. -5, stubbornly refusing to subject the proposals to independent scientific review .

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STATEMENTS FROM MAJOR MENTAL HEALTH ORGANIZATIONS

Association for Women in Psychology website Bias in Psychiatric Diagnosis: Concerns about DSM -V http://www.awpsych.org/index.php/bias -in-psychiatric-diagnosisdsm-v -portal American Counseling Association (ACA) ACAs Counselors for Social Justice American Psychological Association (APA) APAs Division of Humanistic Psychology
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CONCERNS ABOUT DSM & DSM V

False-Positive Diagnoses & Medicalization of Everyday Problems
Empirical Basis? Attention to Culture & Cultural Bias Attention to Context

Secretiveness & Nondisclosure

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CONCLUSIONS FROM CSJ STATEMENT

CSJ does not support: Inclusion or creation of unsubstantiated, empirically lacking diagnostic disorders that may result in unnecessary, harmful, & preventable stigmatization of persons in marginalized & devalued groups in our society.

Creation of unsubstantiated, empirically lacking diagnostic disorders for the purposes of benefitting pharmaceutical companies.
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CONCLUSIONS FROM CSJ STATEMENT CONT.

CSJ endorses: A DSM revision process that results in the development of diagnostic categories that represent empirically validated mental disorders across cultural, societal, & environmental contexts. An open & collaborative process in the development of the DSM-5 & any revisions that would follow.
(c) Julie R. Ancis