Reading many of the parenting social media support groups available online – I can’t help but at times feel uncomfortable at the way diagnostic labels are normalised to identify our children’s mental health. Don’t get me wrong – I am not saying that they should be shelved. There is some place for them.
But is it so simple to classify the human experience? The way we classify children’s mental health has evolved in recent years with the introduction of the DSM-5. As we continue to develop further this new system and what it means for our children, it is important to question how accurately it reflects and diagnoses a child’s mental health.
What are the implications of classifying children under this system? How can we ensure that our children receive appropriate diagnosis and care? These questions and more need to be explored as we seek to better understand this new system.
As a parent navigating the world of mental health care and interventions, you may have heard the DSM5 mentioned in conversations throughout your journey. But what exactly is the DSM-5? The Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition, also known as the DSM-5 or DSM-V, is one of today’s most widely used global classification systems for mental disorders (also known as pathologies).
It provides clinicians and researchers with an up to date framework for making accurate diagnoses across multiple settings — from community services providers to police stations to behavioral health centers. In addition, it describes individual symptoms associated with different types of disorders in detail — providing treatment staff clear guidelines on how best to evaluate clients diagnosed with a particular disorder.
Read on to learn more about this important tool and why it matters when addressing mental health concerns within your family structure and more importantly should parents trust the pathologies diagnosed in the DSM5?
1. What is the DSM-5 and Why Is It Important for Mental Health Care?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the fifth edition of the American Psychiatric Association’s (APA) classification and diagnostic tool, which is used by mental health professionals to diagnose mental disorders. It is one of the most widely used tools in the world for diagnosing mental disorders. It serves as a comprehensive guide for clinicians to assess issues such as diagnosis, prevention, and treatment options. It is also used to identify mental health needs and direct resources toward those in need, as well as inform public policy decisions. It is updated periodically to ensure accuracy and includes information on all aspects of diagnosis, including symptoms, risk factors, and treatment approaches.
2. How Does the DSM-5 Help Diagnose Mental Disorders Accurately Across Multiple Settings?
The DSM-5 provides a detailed description of each disorder, including its symptoms, course of development, associated features, and cultural considerations. This information helps clinicians make an accurate diagnosis based on the patient’s individual presentation. The DSM-5 also includes information about how to differentiate between different types of mental illnesses and how to treat them effectively.
In addition to providing diagnostic criteria, the DSM-5 also offers guidance on treatment planning and management. It outlines evidence-based treatments for each disorder as well as potential risks associated with certain treatments. This helps clinicians create an individualized treatment plan that is tailored to their patient’s needs and goals.
The DSM-5 has been updated since its initial publication in 2013 to reflect new research findings and changes in clinical practice. This ensures that it remains up to date with current best practices in mental health care. By using the DSM-5, clinicians can ensure they are providing their patients with accurate diagnoses and effective treatments for their mental health conditions
3. What Symptoms & Pathologies Are Described in Detail by the DSM-5?
It provides detailed descriptions of symptoms for a variety of different types of disorders, including neurodevelopmental disorders, schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, dissociative disorders, somatic symptom and related disorders, feeding and eating disorders, elimination disorders, sleep-wake disorder, sexual dysfunctions, gender dysphoria, disruptive impulse-control and conduct disorder.
For example: Neurodevelopmental Disorders include Intellectual Disability (Intellectual Developmental Disorder), Communication Disorders such as Childhood-Onset Fluency Disorder (Stuttering) or Autism Spectrum Disorder; Schizophrenia Spectrum and Other Psychotic Disorders include Schizophrenia or Schizoaffective Disorder; Bipolar and Related Disorders include Bipolar I Disorder or Cyclothymic Disorder; Depressive Disorders include Major Depressive Disorder or Persistent Depressive Disorder (Dysthymia); Anxiety Disorders include Panic Disorder or Social Anxiety Disorder; Obsessive-Compulsive & Related Disorders include Obsessive Compulsive Disorder or Body Dysmorphic Disorder; Trauma & Stressor Related Disorders include Posttraumatic Stress Disorder or Acute Stress Disorder; Dissociative Disorders include Dissociative Identity Disorder or Depersonalization/Derealization disorder.
The DSM-5 also provides diagnostic criteria for each type of disorder to help clinicians make an accurate diagnosis. It is important to note that DSM-5 diagnoses are not meant to be used as a substitute for professional medical advice.
4. Who decides on what pathologies and disorders are listed and categorised in the DSM5?
The DSM-5 Task Force is a group of mental health professionals and medical experts responsible for overseeing the production of the DSM-5. The task force is composed of psychiatrists, psychologists, social workers, nurses, and other specialists in the field. Its main goal is to ensure that the DSM-5 reflects current understandings of mental disorders while providing a structured framework for diagnosis and treatment.
The 13 Work Groups are specialized committees within the task force that focus on specific diagnoses. The work groups include representatives from multiple disciplines who review research and make changes to their diagnostic criteria as needed. Together, they are responsible for creating and deciding on the pathologies listed in each edition of the DSM.
5. Why are their criticisms of the DSM5?
The DSM-5 has been widely criticized by a number of prominent figures in the mental health industry, including both psychiatrists and psychologists. These criticisms mainly focus on the DSM-5’s overly prescriptive approach to diagnosis and classification. Psychiatrists such as Dr. Allen Frances, who was the lead editor of the DSM-4 edition, have argued that this approach fails to account for biological factors that could be indicative of mental illness – such as genetics.
Psychologists are also critical of the DSM-5’s diagnostic system, primarily because they argue it is too narrow in its scope and ignores broader and more nuanced definitions of mental illness. Dr. Jonathan Shedler has stated that relying solely on subjective criteria such as personal history and self-reported symptoms can lead to overdiagnosis and misdiagnosis of people who could potentially benefit from treatment but have been deemed healthy by the DSM-5 criteria.
Sociologists have also raised objections to the DSM-5’s reliance on cultural norms when making diagnoses. For example, professor Paula Caplan argued that some cultures may view certain behaviors as indicative of mental illness which are not seen this way within other cultures. This kind of bias can lead to individuals being wrongly labeled as having a mental illness due to cultural values rather than clinical evidence. The tendency for pathologizing behavior based on cultural standards perpetuates discrimination against those who do not fit into certain norms or expectations based on their culture or lifestyle choices. She also argued that the DSM has done more harm than good.
Finally, there has been a great deal of public outcry over the use of the DSM-5 in diagnosing mental health issues, with many arguing that it can lead to over diagnosis or misdiagnosis while ignoring underlying causes or issues related to mental wellbeing. These concerns were echoed in a United Nations report published in 2018 which stated that “the current system heavily relies on subjective criteria alone” without accounting for biological evidence or psychometric testing during diagnosis.
6. Dr. James Davies – author of Mental Health, Capitalism & the Sedation of a Nation
Dr. James Davies is an academic and researcher at Roehampton University in the United Kingdom. He has extensive experience in the field of psychology, having worked as a professor of psychology at the university since 2001. Dr. Davies is an outspoken critic of the DSM-5 and its use in diagnosing mental health issues and disorders.
Specifically, Dr. Davies argues that the DSM-5’s overly prescriptive approach fails to take into account biological evidence or psychometric testing during diagnosis, which can lead to misdiagnosis or over diagnosis of individuals who may not be truly mentally ill but whose behaviors fall outside traditional norms or expectations for their culture or lifestyle choices. He suggests that due to its reliance on subjective criteria alone, such as personal history and self-reported symptoms, it is possible for someone to be wrongly labeled with a mental illness without taking into account any relevant biological evidence or psychometric testing.
Furthermore, Dr. Davies argues that there is a lack of cultural sensitivity within the DSM-5 diagnostic system when it comes to making diagnoses across different cultures and societies. He contends s other critics that some behaviors within certain cultures may be viewed as indicative of mental illness while in others they may be seen as normal, leading to wrongful labeling if clinicians rely solely on the DSM-5 criteria when making medical decisions.
Ultimately, Dr. Davies believes that any diagnosis should be based on multiple sources of evidence rather than just one standardized manual like the DSM-5 if it is going to be accurate and effective at treating mental health issues long term. He calls for more holistic approaches when considering treatment options for those suffering from mental health issues that take into account both physical and psychological factors alike so as not to overlook underlying causes or issues related to those conditions which could potentially benefit from treatment but are being ignored due to an overly prescriptive diagnostic system such as the one found in the DSM-5.
7. Polyvagal Theory and The DSM5?
Polyvagal Theory is a collection of neuroscientific and psychological constructs that provides us with insight into the evolution of the mammalian autonomic nervous system. This theory has been used to explain how our bodies react to different situations, and how our behavior is shaped by this response. It has been found to be particularly useful in understanding and reframing pathology, as it offers us a way to look at disorders from an evolutionary perspective.
The Polyvagal Theory suggests that our autonomic nervous system evolved in order to help us survive in dangerous situations. In these moments, we would either fight or flee depending on the situation. However, if neither of these options was available, we would enter a state of immobilisation – essentially shutting down until the danger had passed. This response is still seen in humans today when we experience fear or trauma, and it can have serious implications for our mental health.
By understanding this evolutionary response, we can begin to reframe pathology in terms of how it relates to our autonomic nervous system rather than simply labeling it as “abnormal” or “dysfunctional”. For example, if someone is struggling with anxiety or depression, they may be experiencing a heightened sense of fear due to their autonomic nervous system being stuck in a state of fight-or-flight. By recognising this underlying cause, we can then work towards helping them find ways to regulate their nervous system and move out of this state.
Or if a child has experienced their childhood with a supposedly safe adult constantly verbally abusing them – they may grow into an adult who lacks the emotional literacy skills to acknowledge or verbalise their needs. By not having their needs met throughout their life span may lead to the onset of depression or explosive anger for example. The title of Dr Bruce Perrys book “What Happened to You?: Conversations on Trauma, Resilience, and Healing” sums up the question that also needs to be asked to fully understand an individual’s mental health challenge.
DSM-5 EXPOSED by Dr James Davies, PhD
DSM5 List of Disorders
DSM5 Fact Sheet – Modifications