March 25, 2010 — Leave a comment

[This post is part of the Adventures in Psychology series]

Some of you may be familiar with the DSM-IV, or the Diagnostic Statistical Manual of Mental Disorders (I’m not sure why the last M and D are dropped in the abbreviation). Recently, a 5th edition has been put together, and the results look rather interesting. The 4th edition had been updated a few years back (yielding a DSM-IV TR as the current model) but this is a full blown new addition with some surprising new disorders in it.

Some may find this as a benefit in the advance of spotting and treating mental disorders, but unfortunately, what it is actually doing is drastically decreasing the percentage of the population that can claim normalcy.

Earlier this month that’s exactly what Allen Francis pointed out in an article for the LA Times:

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day — despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses. (italics added)

In other words, Francis is saying that many of the new “disorders” cited in the updated DSM are being catalogued in the absence of a proven treatment option. However, it would seem that some kind of psychiatric meds will most likely be prescribed for treatment anyway.

Francis himself, who is professor emeritus and former chairman of the department of psychiatry at Duke University, also was the chairman of the committee that gave us the DSM-IV. Knowing a thing or two then about how creating manuals like this works, he makes the following admission about the process:

Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

Given the rundown he then gives of new “disorders,” it seems like this problem has not been corrected in the process, but has been exacerbated. Here’s some of the new disorders you can watch out for:

  1. Binge eating disorder (defined as one eating binge per week for three months)
  2. Minor neurocognitive disorder  (no more than the expected memory problems of aging)
  3. Mixed anxiety depression  (commonplace symptoms difficult to distinguish from the emotional pains of everyday life)
  4. Psychosis risk syndrome (uses the presence of strange thinking to predict who would later have a full-blown psychotic episode)
  5. Autistic spectrum disorder (basically just covers everyone labelled “eccentric”)
  6. Hypersexuality disorder (as Francis puts it “would bring great comfort to philanderers wishing to hide the motivation for their exploits behind a psychiatric excuse.”)
  7. Paraphilic coercive disorder (rapists merit a diagnosis of mental disorder if they get special sexual excitement from raping)

The last one is perhaps the most dangerous, in terms of authorizing rape. How would you feel for instance to be the victim of rape, but then to have the perpetrator let off the hook because he has “paraphilic coercive disorder”?

Francis himself admits to being included in the the first disorder listed (Binge eating), and given the criteria, I would assume every member of a Southern Baptist church that goes out for a big Sunday lunch after church also qualifies.

He notes as well concerning #4 above that “the prediction would be wrong at least three or four times for every time it is correct — and many misidentified teenagers would receive medications that can cause enormous weight gain, diabetes and shortened life expectancy.” That means the disorder will lead to a mis-diagnosis 60-75% of the time. I don’t particularly like those odds.

To sum up though Francis’ thoughts, he concludes with this:

Defining the elusive line between mental disorder and normality is not simply a scientific question that can be left in the hands of the experts. The scientific literature is usually limited, never easy to generalize to the real world and always subject to differing interpretations.

This is an admission many of us as Christians should keep in mind. The DSM is certainly a useful tool, but it is also created without the foundation that man is a sinner and in a certain sense is not normal at all.

It is both interesting on the one hand that the DSM is expanding to include almost everyone with a disorder, because in a certain sense, we all do have a disorder. It is disconcerting on the other hand though because on a large scale the disorder is being grossly misdiagnosed. People are going to be giving more meds for more and more disorders that really are just a sin nature expressing itself more fully.

A category that has been added, but that wasn’t mentioned above is “Behavioral addictions.” Right now it includes binge drinking, but I would imagine compulsive gambling is not far behind (nor is probably addiction to social media). Lack of self-control and selfishness are now well on their way to being  hallmark disorders that afflicts many.

It is helpful as well to see some of the scientific backing to these disorders demystified. Many of the disorders in the DSM are not based on solid scientific evidences, but are merely collections of symptoms that seem to cohabit in a person’s psyche. That is not to say they are not without merit, but it is to say that the DSM should not be treated as infallible as some people treat it. The authors have to strike a balance between being too stringent in categorizing disorders (thus excluding some people who do need treatment) and being too loose in criteria (thus casting the next too wide and catching people who don’t need help).

For now, the DSM V looks like it is continuing the trend from the DSM-IV but expanding the nets even wider so that no anomaly is left uncategorized. From a Christian standpoint, it is confirming what we already know: nobody is normal. But unfortunately, at this point, the problem is still not being identified with man’s sin nature, and so the ultimate solution is likewise not recognized.

It will be interesting though to see what kinds of effects DSM V’s publication will ultimately have. We can hope though that it will in some way push people to see themselves in need, and thus be more and more open to hearing about what they really do need.


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I'm an avid reader, musician, and high school Bible teacher living in central Florida. I have many paperback books and our house smells of rich glade air freshners. If you want to know more, then let's connect!

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