A new Diagnostic and Statistical Manual of Mental Disorders (DSM) is in the works and will be ready for publication in 2013. The DSM is used by mental health professional primarily in the United States to diagnose patients with mental health disorders, such as schizophrenia, bipolar, and depression. Dr. John Sorboro, a psychiatrist, wrote an article for Skeptic Magazine1 questioning the need for a new DSM (the DSM V) while criticizing the current one (the DSM IV-TR). His problems with the DSM are many, and he uses some analogies to incite a reaction, even if negative (e.g., comparing the DSM to the ‘Malleus Maleficarum’ aka ‘The Hammer of Witches’), but he does also make some valid points. In my opinion, the most important problem he points out is that there is an issue with a manual that uses strictly symptomology (most of it revealed subjectively) to diagnose a disorder, which is how the DSM works. Here’s his basic argument. Psychiatric disorders are constructs, models based on observations that fit a specific theoretical framework. In psychiatry, the Major Depressive Disorder (MDD) construct is defined by its symptoms2 (shown below):
Must have at least 5 of these symptoms for at least two weeks:
- Depressed mood for the majority of the day on most day
- Loss of interest in most activities (otherwise known as adhedonia)
- Insomnia or hypersomnia
- Decreased concentration
- Increased fatigue or decreased energy for the majority of the day on most days
- Feelings of worthlessness
- Psychomotor agitation or retardation
- Suicidal ideation
