From DSM 4 to the new 5: Will Controversy lead to overmedication in Psychiatry??

Guidelines that help direct the use of medicines set the starting point for best results. Unfortunately, when controversy erupts from members, colleagues and professionals involved in the field who might experience the new guidelines—a careful review is in order.

DSM-5 is the 5th edition of the Diagnostic and Statistical Manual from the American Psychiatric Association (APA). Information about this is available at www.dsm5.org. Controversy about these pending guidelines (pending for May 2013) arises from more than 3,000 signatures on a petition from professionals, organizations and students expressing “serious reservations”. The petition was sponsored by a division of the APA itself (Division 32, the Division of Humanistic Psychology) which aligned with two other divisions (27 and 49).

DSM-5 is crucial because it covers an amazing array of mental problems, including anxiety disorders, feeding and eating disorders, personality and personality disorders, bipolar and related disorders, neurodevelopmental disorders, obsessive compulsive and related disorders and substance use and addictive disorders. Professionals expressed their concerns in an open letter to the DSM-5 task force citing what they thought were lowering of the criteria (diagnostic thresholds) that it takes for someone to be diagnosed with a particular condition in multiple disorder categories as well as specific proposals that seemed to lack information based on experience (empirical grounding). Also emerging were feelings that if implemented in the present form, DSM-5 might lead to inappropriate medical treatment of certain vulnerable populations.

However this controversy resolves, it’s crucial that any guideline or diagnostic criteria be subject to balanced and objective review and evaluation—especially when the members at large express overt reservations. The clock is ticking and open discussion continues into 2012.

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