What's Wrong With DSM-5?
What's Wrong With DSM-5?
Dr. Strakowski: What would be your recommendation vis-à-vis making diagnostic changes, improving criteria sets, or altering DSM-IV at this particular time?
Dr. Frances: There were 5 problems that emerged since the publication of DSM-4 that urgently needed addressing:
Dr. Strakowski: What approach would you recommend, then, in dealing with these issues? Are criteria change and a new DSM-5 needed, perhaps with fewer new diagnoses as we discussed earlier, or a modification of existing criteria? Or perhaps a more rigorous use of the criteria as they are currently written?
Dr. Frances: For childhood bipolar and autism, I would recommend black box warnings in DSM-5 cautioning against overdiagnosis as well as conferences sponsored by APA and other pertinent associations to reeducate clinicians on proper use of the criteria sets. For ADD: tightening the criteria set. The current DSM-5 proposal would dramatically loosen it. For bipolar II, I would recommend requiring more and longer hypomanic episodes. And last, I would propose rewriting the entire paraphilia section. The DSM-IV wording is imprecise and has been badly twisted in hearings determining involuntary psychiatric commitment under sexually violent predator statutes.
What Would Dr. Frances Do?
Dr. Strakowski: What would be your recommendation vis-à-vis making diagnostic changes, improving criteria sets, or altering DSM-IV at this particular time?
Dr. Frances: There were 5 problems that emerged since the publication of DSM-4 that urgently needed addressing:
The sky-rocketing rates of autism -- an increase of twentyfold
The sky-rocketing rates of childhood bipolar disorder -- an increase of twentyfold
The tripling of rates of ADHD
The doubling of rates of adult bipolar disorder
The misuse of the label "paraphilia NOS" to sanction the questionably constitutional involuntary commitment of rapists as a veiled form of preventive detention
Dr. Strakowski: What approach would you recommend, then, in dealing with these issues? Are criteria change and a new DSM-5 needed, perhaps with fewer new diagnoses as we discussed earlier, or a modification of existing criteria? Or perhaps a more rigorous use of the criteria as they are currently written?
Dr. Frances: For childhood bipolar and autism, I would recommend black box warnings in DSM-5 cautioning against overdiagnosis as well as conferences sponsored by APA and other pertinent associations to reeducate clinicians on proper use of the criteria sets. For ADD: tightening the criteria set. The current DSM-5 proposal would dramatically loosen it. For bipolar II, I would recommend requiring more and longer hypomanic episodes. And last, I would propose rewriting the entire paraphilia section. The DSM-IV wording is imprecise and has been badly twisted in hearings determining involuntary psychiatric commitment under sexually violent predator statutes.
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