In this piece from The New York Times entitled “Why the Fuss Over the D.S.M.-5?,” Dr. Sally L. Satel offers these thoughts about the practical application of the somewhat controversial revised psychiatric manual:
LATER this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion.
The charges are familiar: the manual medicalizes garden-variety distress, leads doctors to prescribe unnecessary medications, serves as a cash cow for the association, and so forth.
But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.
There are dozens of revisions in the D.S.M. — among them, the elimination of a “bereavement exclusion” from major depressive disorder and the creation of binge eating disorder — but they won’t alter clinical practice much, if at all.
This is because psychiatrists tend to treat according to symptoms.
The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.
As you know, we’ve previously written about the DSM and the assistance it can provide in taking depositions of psychological treaters and/or retained testifying experts. In so doing, we’ve noted that such witnesses typically do not employ a formal multi-axial diagnosis under the auspices of the DSM, meaning that if they concede that the DSM is the standard of the industry and that they did not fully consider the factors set forth therein then there are some potential points to be made at the deposition or during cross examination. In June of 2012, we wrote:
. . . [M]any of these experts and plaintiff friendly treaters do not actually employ the formal DSM criteria when making these diagnoses in the first place. Whatever you say about the merits or lack thereof of the DSM-IV, many plaintiffs’ experts and treaters shoot from the hip when making these mental diagnoses. When they see a patient claiming psychological symptoms following a traumatic incident, they immediately leap to a PTSD diagnosis without employing the specific multi-axial diagnosis process. Further, when called upon to analyze the factors set forth in Axis IV, which requires an analysis of - or at the every least, knowledge and consideration of – other environmental or psychosocial factors contributing to the patient’s condition, these providers almost never conduct any independent evaluation.
We see no reason that this analysis will change with the release of the D.S.M.-V.
(Hat tip: Steven Pinker).