Article archive / August 1, 2013
Originally published: . Volume 4, No. 12. Source pages: 8.
Earlier this year, the American Psychiatric Association (APA) released the newest version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V. First published in 1952, the DSM has become the gold standard of psychiatric diagnosis, providing clinicians with a standard way to classify, diagnose, and treat disorders.
This is the first revision of the DSM in almost 20 years. However, changes to the new edition have been met with some mixed views, debate, and even some resistance.
The Times spoke with Dr. William McCown of the University of Louisiana- Monroe (ULM), Dr. Tony Young of Louisiana Tech, and Dr. Gary Gintner, to learn more about the controversial changes surrounding the new DSM-V.
“I think there are some problems with the DSM- V…the whole process was kind of closed and everyone is confused about what happened,” Dr. Bill McCown told the Times. McCown is a licensed clinical psychologist and Interim Dean of the Graduate School at ULM.
“What’s very frustrating with the DSM-V,” he said, “is that they wanted to get rid of a lot of the ambiguity, and we’re not there yet.”
Dr. Tony Young, Chester Ellis Endowed Professor in Education in the Department of Psychology & Behavioral Sciences at Louisiana Tech, and licensed clinical psychologist, also expressed concern when asked about the new changes. “One of the biggest concerns is the broadening of diagnostic categories. They are more inclusive, so more people wind up with the disorder,” Young said.
Some of the new changes, such as combining the Autism subcategories into one disorder, have caused concern among those in the mental health community. Some are unhappy with the new categories, believing they are in response to pharmaceutical pressures.
Dr. Young told the Times, “The way the field [psychiatry] works and its coziness with the pharmaceutical industry, I’m not sure people are going to go with it anymore. I’m concerned that this is where it ends, because we’re ready for a change, we’re ready for information that is independent of market forces.” He referred to other groups, such as researchers, who also use the DSM. “There needs to be a more concerted effort for people who are scientists outside the guild who are most affected by the categories.”
McCown echoed Young’s sentiment, “Sixty-nine or seventy percent of the people [developers] had ties to the pharmaceutical industry, that’s scary.”
When asked what should have been done differently with the new version, McCown said, “It would have been nice if each description was based upon some summary of how much was empirical vs. how much was just expert opinion or from people in the pharmaceutical industry.”
The question remains as to whether users of the DSM will begin to seek alternatives, such as the International Classification of Diseases (ICD). Currently, most insurance companies request that disorders be submitted using ICD codes, so diagnosticians already have some familiarity with the publication.
“Some of the people I have talked to said they have already gone to the ICD…there are not dramatic differences between them,” said Young. When asked whether the ICD would be a strong alternative to the DSM-V, “Insurance companies would prefer you use the ICD,” he said.
Dr. Gary Gintner, Associate Professor and Program Leader of the Counseling Program at Louisiana State University, and Licensed Professional Counselor, has been doing DSM workshops since the 1990s. He has trained people around the country and recently presented for the Ohio Psychological Association on the DSM-V. He will be presenting at the Annual Meeting of the Louisiana Counseling Association this September.
Gintner sees the new DSM more favorably, and notes that the ICD and DSM work together, the ICD being a coding manual. “What people don’t understand is that we’ve always used the ICD codes. The ICD codes are your administrative codes, but the resource you use to understand and make the diagnosis––that is the DSM.” He views the new manual as having the value of coming more from the development perspective, but he says, “There is a major paradigm shift going on,” and people will have an adjustment period.
A feeling shared by both Drs. McCown and Young was that, “Time will tell.” Whether the new DSM-V has finally reached the tipping point that causes mental health professionals to go elsewhere remains to be seen.
The controversy surrounding the new text has not gone unnoticed and seemed to peak with the announcement that the National Institute of Health would no longer fund research for DSM categories.
With its future uncertain, one can’t help but wonder what will happen to the once denoted “bible” of psychiatric diagnosis.
(Shane Lowery, MS, is a LSU industrial-organizational psychology doctoral student and Times’ intern.)
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.