The Chair of the DSM-IV Task Force charges that the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lacks sufficient scientific support, defies clinical common sense, and was prepared without adequate consideration of risk-benefit ratios and the economic cost of expanding the reach of psychiatry.
He recommends that physicians use the DSM-5 cautiously, if at all. In 1980, the DSM-III was developed to give physicians specific parameters by which to define and diagnose mental disorders. It was thought that the DSM-III could make psychiatric diagnosis more reliable and accurate. However, psychiatric diagnosis still relies exclusively on subjective judgments rather than objective biological tests, and diagnostic inflation is at crisis level, the author writes.
The fourth edition of the DSM, the DSM-IV, addressed some of the issues of the previous edition by taking a conservative stance of discouraging all changes and requiring substantial scientific evidence for them. Of 94 suggested new diagnoses, only two were added. But according to the author, market-driven diagnostic fads resulted in significant increases in the diagnosis of attention-deficit disorder (tripled), bipolar disorder (doubled), and autism (20-fold increase).
The recently published fifth edition, or DSM-5, ignored the risk of overdiagnosis and introduced several high-prevalence diagnoses that may actually be everyday problems labeled as psychiatric disorders. The author argues that drug companies will take marketing advantage of the loose DSM definitions by promoting medications to address the chemical imbalances that cause those "disorders."
According to the author, the DSM-5 review process was secretive, closed, and disorganized, with deadlines being consistently missed. The American Psychiatric Association refused a petition for an independent scientific review of the DSM-5 that was endorsed by more than 50 mental health associations. The author asserts that publishing profits trumped public interest.