The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), originally designed for research purposes, has become very influential in the field of psychiatry, even though it has always been heavily criticized in some quarters.

An analysis of the American Psychiatric Association’s internal documents, published in 2008, shows the extent to which the different versions of the DSM (up to the DSM IV-TR currently underway) reveal a lack of rigour and an arbitrariness that can lead to confusion. One person who was heavily involved in drawing up the most recent DSMs has become alarmed at the plan to include new “pathologies” in the next DSM V, scheduled for publication in 2012.

These include “the risk of psychotic syndrome”, “minor neurocognitive disorders”, etc, which will inevitably become commonplace thanks to the marketing ploys of pharmaceutical companies, resulting in people needlessly being given treatments that are ineffective and carry the risk of severe adverse effects.

The draft DSM V also lowers the number of criteria for the diagnosis of some disorders. This is the case for example for attention-deficit hyperactivity disorder, where the number of symptoms necessary for this condition to be diagnosed in adults is halved; major depression is extended to bereavement, etc.

These warnings highlight the need to be wary of the DSM, of pharmaceutical companies’ marketing, of disease-mongering, and of the medicalisation of life.

©Prescrire January 2011

"DSM-V: madness!" Prescrire Int 2011; 20 (112): 24  (pdf, free).