Do you agree or disagree that the DSM should be updated every several years?

Answer 1

OK! So I haven't finished my assignment and this is only a draft, but once I noticed this question, I figured I'd help the best I could.

Major Assignment in Introduction to Psychosocial Rehabilitation

Diagnostic and Statistical Manual Updates: Thoughts and Opinions

Due August 1st, 2010

For Ms. Ruth Woodman

St. Lawrence College - Cornwall Campus

History of the Diagnostic and Statistical Manual

The initial impetus for developing a classification of mental disorders in the United States was the need to collect statistical information. The first official attempt was the 1840 census which used a single category, "idiocy/insanity". The 1880 census distinguished among seven categories: mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy. In 1917, a "Committee on Statistics" from what is now known as the American Psychiatric Association (APA), together with the National Commission on Mental Hygiene, developed a new guide for mental hospitals called the "Statistical Manual for the Use of Institutions for the Insane", which included 22 diagnoses. This was subsequently revised several times by APA over the years. APA, along with the New York Academy of Medicine, also provided the psychiatric nomenclature subsection of the US medical guide, the "Standard Classified Nomenclature of Disease", referred to as the "Standard". [1]

2010 and Beyond... A Segue

one-hundred and thirty years later we have now advanced our medical and psychological research; evolved into numerous fields stemming from psychology (including clinical psychology, child psychology, educational psychology, social psychology and comparative psychology [2]); and have performed many more neurological, behavioral, and psychological tests. It would be foolish to believe that humans have a parallel understanding of our cognition and the encephalon as we did in the late 19th century.

Reason #1 for updating the DSM: Social Change and Psychopathology - Evolution in Diagnoses

Second paragraph extracted from "The Pathoplastic Effect of Culture on Psychotic Symptoms in Schizophrenia"

"Socioculturalism" creates a transmutation on the form, course and outcome of major psychiatric disorders, and as such can be considered as "pathoplastic", i.e., it molds rather than causes psychopathology. Thus, it is important to recognize this pathoplasticity since it may alter a diagnosis.

"Contemporary psychiatry attempts to clarify etiological and pathogenetic aspects of a number of suspected 'biological' disorders, like sever affective disorders and schizophrenia, primarily by means of biomedical methods. But there are phenomena like contents of delusions which cannot be easily explained by biological or allied socio-medical sciences. Although it is generally accepted knowledge that prevalence and shape of certain psychotic phenomena are influenced by cultural patterns, the degree of the pathoplasticity of these symptoms is yet unknown. Based on date of the International Study on Psychotic Symptoms (ISPS) including 1080 subjects from Austria, Poland, Lithuania, Georgia, Pakistan, Nigeria, and Ghana we tried to estimate the culture-sensitive variance of contents of delusions, hallucinations and first rank symptoms. We found rates between 15% and 40% by means of canonical discriminant analysis. Our results confirm cultural psychiatry as an important tool for the understanding and consequently for the treatment of patients with major mental disorders."

As DSM-III chief architect Robert Spitzer and DSM-IV editor Michael First outlined in 2005, "little progress has been made toward understanding the pathophysiological processes and etiology of mental disorders. If anything, the research has shown the situation is even more complex than initially imagined, and we believe not enough is known to structure the classification of psychiatric disorders according to etiology."[3] Also, "it has been suggested that the DSM-V requires greater sensitivity to cultural issues and gender; needs to recognize the need for others to change as well as just those singled out for a diagnosis of disorder; and that it needs to adopt a dimensional approach to assessment that better captures individuality and does not erroneously imply excess psychopathology or chronicity".[24] These claims express the DSM's room for improvement on the matter at hand.

For additional information and more intriguing reads regarding sociocultural influences on mental health, please continue reading The Pathoplastic Effect of Culture on Psychotic Symptoms in Schizophreniaby Thomas Stompe, Hanna Karakula, Palmira Rudaleviciene, Nino Okribelashvili, Haroon R. Chaudhry and E. E. Idemudia, S. Gscheider and consider Sociology of Depression - Effects of Cultureby Rashmi Nemade, Ph. D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Reason #2 Modern Technology = Problems

Nomophobiais the fear of being out of mobile phone contact. [4][5][6] The term, an abbreviation for "no-mobile-phone phobia", [7] was coined during a study by the UK Post Office who commissioned YouGov, a UK-based research organization to look at anxieties suffered by mobile phone users.[8] The study found that nearly 53 percent of mobile phone users in Britain tend to be anxious when they "lose their mobile phone, run out of battery or credit, or have no network coverage". [9][10]

Video game addiction, or more broadly video game overuse, is excessive or compulsive use of computer and Video Games that interferes with daily life. Instances have been reported in which users play compulsively, isolating themselves from, or from other forms of, social contact and focusing almost entirely on in-game achievements rather than broader life events.[11][12][13] There is no diagnosis of video game addiction, although it has been proposed for inclusion in the next version of the Diagnostic and Statistical Manual of Mental Disorders. [14][15][16]

Information of Modern Technology = Problems portion graciously provided by Wikipedia.

Reason #3 New ResearchDrawn from the DSM's official website: "Now that each of the DSM-5 Work Groups are finalizing their draft diagnostic criteria, the next phase of DSM-5 development will focus on implementation of field trials, which are scheduled to begin in summer 2010. Based in part on feedback received from visitors to this Web site, work groups are revising their draft criteria and, along with the DSM-5 Research Group, selecting which diagnostic criteria sets are most in need of field testing. The overall aim of the Phase I DSM-5 Field Trials is to assess the feasibility, clinical utility, reliability, and (where possible) the validity of the draft criteria and the diagnostic-specific and cross-cutting dimensional measures being suggested for DSM-5.

"A limited number of standardized and methodologically strong study designs are being used to enhance our ability to compare test results across various sites and disorders. Specifically, members of the DSM-5 Research Group have created two standardized protocols for the DSM-5 field trials. One version, is designed for academic or other large clinical settings with established research infrastructures. In these settings we will be able to assess the clinical utility, feasibility, reliability, and where possible, the validity of selected DSM-5 draft diagnostic criteria as well as the clinical utility, feasibility, reliability, and sensitivity to change of the cross-cutting and diagnostic-specific severity measures. The second version, will focus on solo practitioners and smaller routine clinical practice settings. This second design will focus on the clinical utility and feasibility of the selected draft diagnostic criteria as well as the clinical utility, feasibility, and sensitivity to change of the cross-cutting and diagnostic-specific severity measures.

"After completion of Phase I Field Trials and a second wave of public comment via this Web site, work group members will make any necessary revisions to their draft criteria. This will be followed by Phase II DSM-5 Field Trials for further examination of selected revisions, scheduled to take place in 2011 and 2012."

To reinforce the argument for updating the DSM, the new Diagnostic and Statistical Manual proposes including the following: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence; Delirium; Dementia; Amnestic, and Other Cognitive Disorders; Mental Disorders Due to a General Medical Condition Not Elsewhere Classified; Substance-Related Disorders; Schizophrenia and Other Psychotic Disorders; Mood Disorders; Anxiety Disorders; Somatoform Disorders; Factitious Disorders; Dissociative Disorders; Sexual and Gender Identity Disorders; Eating Disorders; Sleep Disorders; Impulse-Control Disorders Not Elsewhere Classified; Adjustment Disorders; Personality Disorders [17].

Criticism: The Other Side of the Coin

Canadianized version of the Reliability and validityportion of Wikipedia's Diagnostic and Statistical Manual of Mental Disordersdefinition.

The most fundamental scientific criticism of the DSM concerns the validity and reliability of its diagnoses. This refers, roughly, to whether the disorders it defines are actually real conditions in people in the real world, that can be consistently identified by its criteria. These are long-standing criticisms of the DSM, originally highlighted by the Rosenhan experiment in the 1970s, and continuing despite some improved reliability since the introduction of more specific rule-based criteria for each condition. [3][18][19][20]

Proponents argue that the inter-rater reliability of DSM diagnoses (via a specialized Structured Clinical Interview for DSM-IV (SCID) rather than usual psychiatric assessment) is reasonable, and that there is good evidence of distinct patterns of mental, behavioral or neurological dysfunction to which the DSM disorders correspond well. It is accepted, however, that there is an "enormous" range of reliability findings in studies, [21] and that validity is unclear because, given the lack of diagnostic laboratory or neuro-imaging tests, standard clinical interviews are "inherently limited" and only a ("flawed") "best estimate diagnosis" is possible even with full assessment of all data over time.[22]

Critics, such as psychiatrist Niall McLaren, argue that the DSM lacks validity because it has no relation to an agreed scientific model of mental disorder and therefore the decisions taken about its categories (or even the question of categories vs. dimensions) were not scientific ones; and that it lacks reliability partly because different diagnoses share many criteria, and what appear to be different criteria are often just rewordings of the same idea, meaning that the decision to allocate one diagnosis or another to a patient is to some extent a matter of personal prejudice. [23]

Diagnostic and Statistical Manual in Psychosocial Rehabilitation

Emphasis should be placed on a misdiagnosis. If the DSM is not updated, or refuses to modify certain details or information concerning literature that has already been published in previous issues, a matter is at hand. Workers are unable to properly take care of clients or "patients"; the latter are not presented with proper/suitable treatment options; and most pertinently, the rehabilitation process is astray.

"Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria".[25]

Conclusively

A dramatic amelioration in information-gathering and understanding of the human mind has led to many "proposed" additions to the DSM - not excluding a relatively "new" consideration on sociocultural influences towards mental health. Yet a properly updated manual means many can no doubt further understand "new" mental health issues and share these updates with clients, associates, and the curious. Of course, many mental disorders derive from man-made causes which were previously nonexistent. Dependencies to things such as video games, television, computers, hand-held devices and the new "street drug" are all evolutionary disorders (though all addictions) caused by social changes and stimulating products - this being information pertaining to mental health we could never have diagnosed/known/predicted many years ago or were non-applicable when the DSM first was written! So let us update the DSM to better suit these modifications.