The American Psychiatric Association (abbreviated as "APA") is prepared to publish the next edition of the Diagnostic and Statistical Manual of Mental Disorders (abbreviated as "DSM"). The fifth edition of the DSM contains a definition for what is and is not a "mental disorder" that is ambiguous and open to individual interpretation by the diagnosing party. Said definition, copied from the development website (specifically the page located at: http://www.dsm5.org/proposedrevision/Pages/proposedrevision.aspx?rid=465), reads as follows:
"A Mental Disorder is a health condition characterized by significant dysfunction in an individual's cognitions, emotions, or behaviors that reflects a disturbance in the psychological, biological, or developmental processes underlying mental functioning. Some disorders may not be diagnosable until they have caused clinically significant distress or impairment of performance.
A mental disorder is not merely an expectable or culturally sanctioned response to a specific event such as the death of a loved one. Neither culturally deviant behavior (e.g. political, religious, or sexual) nor a conflict that is primarily between the individual and society is a mental disorder unless the deviance or conflict results from a dysfunction in the individual, as described above."
Note that this definition does not contain any specificity as to what is (or, perhaps more significantly, is not) a "significant dysfunction". In many cases, the entries for disorders within the DSM also have this problem. This leads to a loophole in the definition that allows the diagnosing party to make a diagnosis based on their own opinion of what is and is not a significant dysfunction, allowing personal prejudices to be applied in a clinical setting without being closely monitored for results by someone other than the diagnosing party. Symptoms are therefore personal interpretation by the diagnosing party, rather than recorded and specific signs of a genuine dysfunction. Behaviors that result from previous experience, such as cautiousness in certain situations resulting from trauma, are not routinely considered. Under this definition, the diagnosing party is left free to interpret what is and is not significant dysfunction in persons other than themselves, without proper interrogation or testing.
The DSM explains which dysfunction is a symptom of which disorder. It does not provide any way to check the context and validity of perceived symptoms (such as a way to check that the apparent "symptom" is not merely a conflict between the diagnosing party and the individual being diagnosed—they are both, after all, people, and may not tolerate one another). In fact, the diagnosing party often fails to perform such checks at all, especially when left to their own devices. It does not mention that it is possible that supposed symptoms could be a result of something other than a mental disorder—the person suspected of having a disorder may merely be uncomfortable with the questions being asked or the environment they are being questioned in. Using the provided definition, it is also up to the diagnosing party as to what are and are not behaviors, emotions, and cognition caused by a genuine dysfunction in an individual.
The issue is not resolved by the definition's associated text, which reads as follows:
"The diagnosis of a mental disorder should have clinical utility: it should help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients. However, the diagnosis of a mental disorder is not equivalent to a need for treatment. Need for treatment is a complex clinical decision that takes into consideration such factors as symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient's distress (mental pain) associated with the symptom(s), disability related to the patient's symptoms, and other factors (e.g., psychiatric symptoms complicating other illness). Clinicians may thus encounter individuals who do not meet full criteria for a mental disorder, but who demonstrate a clear need for treatment or care. The fact that some individuals do not show all symptoms indicative of a diagnosis in these individuals should not be used to justify limiting their access to appropriate care.
This definition of mental disorder was developed for clinical, public health, and research purposes. The inclusion of diagnostic categories such as Gambling Disorder and Pedophilic Disorder does not imply that such conditions meet legal or other nonmedical definitions of mental disease, mental disorder, mental defect, or mental disability. Additional information is usually required beyond that contained in the DSM-5 diagnostic criteria in order to make legal judgments on such issues as criminal responsibility, eligibility for disability compensation, and competency."
In fact, the associated text has its own set of issues: by stating that some patients may not display all the diagnostic criteria of a disorder but may still need treatment, and also that some patients who clearly display all diagnostic criteria for a disorder may not require treatment, it leaves the issue of whether or not something should be treated up to even more personal interpretation by the diagnosing party.
There is also a distinct lack of any considerations to be taken when making a diagnosis. For example, if the patient meets all of the criteria to be diagnosed with a disorder, but does not need treatment or even special consideration, the stigma associated with their diagnosis may outweigh any potential benefit. Diagnosis without a need for treatment actually goes against the definition provided for what is and is not a mental disorder: if the patient is experiencing significant distress or dysfunction-which they need to be to warrant a diagnosis in the first place-why should they not be treated?
Such things should be clarified, as psychiatry and psychology are clinical applications and need as little room for personal error as possible to work properly and ensure the health and safety of the patients. I suggest the definition be edited to stress the point that a personal prejudice possessed by the diagnosing party is not a dysfunction in the individual being diagnosed. An entry could be added to assist diagnosing parties with remaining objective in their work, and more information on what level of distress or dysfunction is required for diagnosis should be a necessary inclusion in the diagnostic criteria for any disorder. I request that the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders be delayed until these, or better, changes are made to prevent the harm the current definition and its associated text may cause.
Tell the American Psychiatric Association that illness should not be open to interpretation!
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