Criticism of DSM-V Continues: What’s In the Manual Anyway?

Illustration of open bookThe recent revelation that Dr. Drew Pinsky, who cohosted Loveline and now has his own show, recommended antidepressants for off-label use after being paid to do so has reinvigorated debate about that prescription drug and use of psychiatric medication in general. This debate is increasingly visible in the discussion over the soon-to-be-released edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM is the bible for mental health professionals. Originally developed to make the diagnosis of mental health conditions more uniform across locations and between professionals, it has been met with criticism from its inception. The fifth edition of the manual is planned for release in 2013. Like previous editions, it has expanded the criteria for some diagnoses, incorporated new illnesses, and attempted to further codify diagnosis of mental illnesses. But also like previous editions, it has been met with criticism by mental health skeptics and mental health professionals alike. So what are the major changes in this book? Here’s a brief overview.

Changed Diagnostic Thresholds
Several mental health conditions, including pedophilia, general anxiety disorder, and attention deficit disorder now have altered diagnostic criteria. The result is that people must exhibit fewer symptoms to be diagnosed with these illnesses. While supporters of the DSM-5 argue that this makes getting treatment easier, skeptics argue that these expanded diagnostic criteria can serve to pathologize normal behavior.

Behavioral Addictions
Drug and other addictions have long been part of the DSM, but the new DSM-5 takes into account changing social norms and technologies. While previous editions itemized specific addictions, the new edition offers the “addiction and related disorders” category. This category incorporates several new behavioral addictions, including internet addiction and shopping addiction.

Assessment Tools
The new manual contains several assessment tools to assess the severity of a mental health condition. It also contains a new guide for assessing the suicide risk of people with certain mental illnesses, particularly depression. While these tools are aimed at assessing treatment and needs of patients and clients, some skeptics argue that these assessment devices are not backed by empirical research.

Personality Disorders
Personality disorders have long been criticized by skeptics as examples of unclear and nonspecific diagnoses that may pathologize normal or transient behavior. The new manual aims to answer this critique with a radical overhaul. The new manual will focus on impairments in functioning rather than specific personality traits. An “impaired sense of self-identity” will be a critical component of personality disorders, and some personality disorders such as histrionic personality disorder and schizoid personality disorder will be radically altered or eliminated entirely.

Childhood Disorders
With increasing public concern about autism, the DSM-5 refines and expands the definition of autism. It also offers a new childhood diagnosis: Disruptive mood dysregulation disorder is a diagnosis offered to children who throw extreme temper tantrums that are not developmentally appropriate. While the American Psychiatric Association argues that this can help parents pinpoint behavior that is abnormal—and potentially predict future mental health problems—critics point out that this will likely result in an increase of antipsychotic prescriptions for children.

Transparency and Public Relations
The American Psychiatric Association (APA) originally required that participants in the revision process sign a nondisclosure agreement, prompting critics to argue that without transparency, there was no real way to criticize the process by which disorders are codified. The APA has since backed off of this requirement but has used a public relations firm to market the manual. While the APA argues that this helps mental health professionals and laypeople to be aware of the changes, some critics argue that this distorts the process of mental health diagnosis and turns it into a money-making public relations venture.


  1. Carey, B. (2008, December 18). Psychiatry’s struggle to revise the book of human troubles. The New York Times. Retrieved from
  2. DSM-5 draft promises big changes in some psychiatric diagnoses. (n.d.). MedPage Today. Retrieved from
  3. DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use likely to rise. (n.d.). Psychiatric Times. Retrieved from
  4. Psychiatrists propose revisions to diagnosis manual. (n.d.). PBS. Retrieved from

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Earl Scruggs, “Talk of the Nation,” and Grief
Let’s Rethink the Concept of Mental Disorder
Binge Eating Disorder and Health at Every Size

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  • andrew


    July 9th, 2012 at 11:17 AM

    If drs are having to use pr firms to promote the new manual, then I would say that we have some pretty serious issues going on within the world of psychiatry and psychology.
    Wouldn’t you think that to providers who are well educated that the manual revisions would be self explanatory and they wouldn’t have to have someone talking it up, and selling it on them so to speak?
    Maybe there are some clear deficiencies in the manual that should be identified as causing confusion for drs and patients alike. And that attention should then be paid to in order the bridge the gaps that these misunderstandings could create.

  • Brent


    July 9th, 2012 at 4:15 PM

    What exactly is wrong with changing criteria so that someone can be diagnosed by exhibiting fewer symptoms? Don’t you think that this will actually expose more people with mental health problems and POSSIBLY catch them before they do harm to themselves or others?

  • Denise


    July 10th, 2012 at 4:25 AM

    I hardly see how changing something for the better can cause such an uproar.

    We are all supposed to evolve and change and with that should go the diagnostic tools that professionals use in order to provide quality care to their patients and clients.

    So what if there are a few things that you may not agree with? Just be the professional that you are and use it to your best abilities. You use it as a guide, as a roadmap.

  • Jacqui Moore

    Jacqui Moore

    July 10th, 2012 at 11:14 AM

    I guess since I am not a trained therapist I do not understand why moving forward and tweaking a few definitions has so many people up in arms.
    It’s not like they’re changing the Bible or anything like that.
    As long as patients are able to receive the care that they need that is appropriate for them and in a manner that is timely and professional, do you really have to seek the answers in this manual anyway?
    I would hope that a successful therapist would probably be able to operate just fine without this most of the time.

  • AQ


    July 10th, 2012 at 11:44 PM

    Diagnosis with fewer symptoms?The rates of that particular disorder could shoot up for one.And when that happens the related treatment and pharma markets are affected and maybe even the insurance companies could reflect the trend.Not too far fetched is it?

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