DSM 5: Changes to psychiatry manual: Problems in mental health

America is facing a serious problem concerning the way we handle mental health.

We have high rates of people with "diagnosable mental illness," estimates vary, but the number is as high as 34% according to some.psychcentral.com...

One reason for this is the lack of a healthy mental culture in many ways.

Another reason is the rising number of classifications of mental illness.

And the way these disorders are treated is not helping matters. We must consider mental health a part of lifestyle, instead of only addressing it when there is an issue. Too often, people end up having a breakdown that may have been prevented if mental health was held as a consistent priority and underlying issues had been dealt with.

Too many people end up with a prescription that may have been avoided if we had a society that did a better job assisting people in developing a healthy mentality.



This is an epidemic throughout all of our health systems, and is similar to how treatment is always the answer above preventative care.



Top 25 psychiatric prescriptions

Some new diagnosis have been approved for the DSM 5, which is expected to be released in May 2013.



The psychitric establishment continues to add disorders and expand the net for mental illness. There are clear conflicts of interest: it is a business and so is the prescription drug industry. By nature, patient health will not always be the primary goal.

I found this article from Psychology Today- DSM 5 Is a Guide, not a Bible. Ignore it's 10 worst changes.

This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound.

This is coming from a psychiatrist. Psychiatrist's and psychologists are generally good people in my experience. We need more of them, and we need it to be an accepted part of our culture to consistently work on one's mental health with some kind of expert starting in youth.

What has to change is the culture of psychiatry. Too quick to diagnose and prescribe. Consulting mental health experts should be encouraged for everyone, not just the ill. Doing so would reduce the incidence of mental crisis.

Here are some of the new disorders:

1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder

2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.

3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia.

4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs

6) The changes in the DSM 5 definition of Autism will result in lowered rates- 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups.

7) First time substance abusers will be lumped in definitionally in with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.

8) DSM 5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot.

9) DSM 5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life.

10) DSM 5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.

Generally, the new DSM makes diagnosing and prescribing much easier. The result may be a society where more and more are slapped with a mental disorder and given a bottle of pills for it. This is a trend that needs to be reversed if we seek to reduce our reliance on drugs and live a consistently healthy life.

Don't get me wrong, there are many people who are genuinely mentally ill and can benefit from prescription. But we are trending toward inflating the reality of this situation. Not this many people are in need of prescription and worthy of a disorder diagnosis. More often than not, progress can be made with therapy, change in lifestyle, and general introspection.

Another thing to worry about is the association between mental illness and crime. More people are going to be viewed skeptically when getting a background check, if the diagnosis is found. People who are high functioning, good citizens, but have some diagnosis may have a hard time buying a firearm.



I was diagnosed bipolar three years ago and prescribed two medications. At first I fought the diagnosis, and fought the medication even harder. Now I realize that I can accurately be described as bipolar. I do have depressive and manic tendencies. Have my whole life. But, I can manage these without medication and have for a year now. I have functioned well and had no episodes. The key is living a healthy lifestyle, learning the triggers, coping skills, and examining one's own psychology. I am confident that I can live a fully functional life without relying on medication.

When I was first diagnosed, I was at an inpatient mental hospital. My mom had encouraged me to seek help when I was in the midst of a manic episode. I was constantly arguing with the people there about my diagnosis and medication. They were right about some of the things, but I think I was right about others. A particular exchange sticks out when I think about it.


"Has anyone ever come here and you did NOT give them a prescription for medication?" I asked

"Ummm...no, not that I can remember." My psychiatrist said.


That's a problem. Everyone who walks in the door having an episode or some kind of crisis shouldn't be told that they can manage a disorder with medication indefinitely. I had been going through a particularly difficult time, and I'm sure many who end up in these types of places are as well. Often times a mental illness can be temporary, and worked through. Or if permanent, it may be managed without drugs if one lives the proper lifestyle.

I'd like to hear some thoughts on all this.


Here are some related links from ATS:
I don't have a disorder..according to this you do!

Soon noone will be classified as normal according to Mental Health experts

Our society has elements that can drive us nearly insane, and we have a medical establishment that is quick to tell us that we in fact do have a disease that can be fixed with a pill.

There are over 300 disorders in the DSM, many with vague criteria that can apply to many people.

Often a diagnosis is given when observing a patient during crisis, and without the proper context of an entire life.

The stigma that those who seek mental treatment are "crazy" is a major problem as well. Pretty much everyone goes through periods where they are a bit unstable, and we need to be more understanding toward those who seek help.

Fear mongering makes someone who would otherwise seek psychiatric attention, refuse it.

All because some think people with mental disorders should survive without medication. Many of these psychiatrists got into this profession in order to help people, but every self harming loon thinks they know better after spending 5 hours a night picking at their face and pulling out hair.

It took thousands of years for us to downgrade mental disorder from demon possesion to something treatable with therapy and medication.

Lets all just hang in there and try to help these professionals do their jobs.

34%? Just to add something to this.... When I was in school in the 80's, the Nurse's office had a plastic tub .... a small one...with controlled substance type meds for students. When I was at my Son's school earlier this year to drop something off, I had to see the nurse for some issues as well. The Nurse in HIS school has a stand up, full size Mechanics chest like the red Snap-On chests you see in a well appointed car shop. It's full...every tray from top to bottom...with controlled substance meds for the kids at the school.

Whats happened, in my view, is that we've entered a period where no problem doesn't have an Rx solution and no mental issue is beyond the reach of the modern version of 'Momma's little helper'. The problem? Well... My Son is on 2...they'd like to see it be 4. Literally MOST people I know now...that is literally a majority to include those at college..are on SOMETHING related to mental issues. ADHD...ADD, Bi-Polar, Autistic Spectrum etc etc. Something.

It's a scary world and 34%? I think someone that is making stats needs to get out of the office more. I'd say, on personal experience? Closer to 50-60% in the school system I have a child in today.

reply to post by Wertdagf


I'm not fear mongering. I'm pointing out some serious flaws in the way mental illnesses are handled. I encourage everyone to make their mental health a priority, and if they have a serious problem they should seek the appropriate treatment.

My point is that many who get diagnosed are normal and fully capable of living without medication.

It should always be on a case by case basis, and I think medication should be reserved for cases where other paths are not effective. Right now, treatment is largely generalized.

reply to post by Wrabbit2000


You're right it could easily be more. I saw some estimates that were lower, around 22%. There is a possibility that the data is under reported, considering the stigma involved.

Regardless, it is trending up and it seems likely that within 10 years ago the statistic will start approaching 50%.

Maybe it's a good thing. If the majority are diagnosed, we may be able to have a more honest and open discussion about mental health within our society.

I think there are many reasons for all these new "disorders" that are being invented.
As you already stated, the drug manufacturing industry plays a major role. But I think the Govt. Is also sticking it's hand in. With regards to gun control, everyone who is labled with a disorder, can eventually be disqualified from being allowed to own firearms.

Then there is the trend in our society where more and more people are looking for ways to avoid personal responsibility. "It's not my fault, I have a condition that makes me drink and drive, rape children, beat my wife..."

I remember a story last year where eating healthy had been labeled a mental disorder.

This stuff is getting completely out of hand, and I for one don't like it.

Where does it end?

reply to post by PatrickGarrow17


That list was eveloped in the think smell of fear.

Almost all people need to be stabalized with medication first.... then you can get close and start ironing out the details. I think your looking at this from the wrong end. These people are mothers and fathers... they are there to help you... they spent potentialy a hundred thousand dollars to end up in a profession where they watch the worse case senarios everyday.

EXcellent thread - right up my alley. S/F!!

I am a retired clinical social worker - mental health therapist. I spent oodles of money getting an advanced degree toward that end at the turn of the century, and learned a whole bunch about how society uses tools like the DSM. My copy of the DSM IV-TR (Diagnostic Statistical Manual, Fourth edition, text revision is the long name) is dog-eared, paper-clipped, highlighted, bookmarked, and ratty.

First I want to address your personal experience within the mental health system; you are obviously a very astute "consumer", and have done the work required (yep, required) to improve your own functioning. Most people who seek mental health treatment are either coerced into it by others, or forced into it. Oftentiimes it is at "rock bottom" that people will seek help.

There is too much of a stigma on "Behavioral Health", and you are absolutely SPOT ON that everyone can beneft by entering willingly into a partnership with a professional trained to help develop introspection and self-management skills -- either to identify and learn to change counterproductive skills, or to learn productive ones. The skills that a person develops to cope in the world are a direct result of their environment and the conditions in which they find themselves. No life is perfect. No parent or family is perfect. No person is perfect either, and each of us has an individual temperament and response to the world in which we find ourselves.

Therefore, mental health counseling is an ART as well as a SCIENCE. It depends MOSTLY on relationship and trust, communication skills, and the willingness of both parties to be honest.

That said, there are difference between the three different "Mental Health Professional" titles.

The types of professionals' educations depend on where they went to school. I went to a very well-respected Public University, which has its own hospitals and School of Medicine (teaching hospitals), as well as a School of Social Welfare; and studied under Psychiatrists, Psychologists, and Social Workers. I learned a great deal about how the system works. Keep in mind that every school has their own "curriculum", and not all schools teach the same philosophies.

My academic institution turns out these styles:

A Psychiatrist is an M.D. A medical doctor. They got the same early training as doctors like your family practitioner or oncologist or phlebotomist, etc. They may OR MAY NOT have received indepth training for what we call "bedside manner" or empathy. They are the ONLY ONES who can prescribe.. Their mindset is to see clients as SICK, as PATIENTS, and their job is to CURE the ILLNESS and be the EXPERT. Telling the person what is wrong with them, and handing out pills (or shock treatments or blood-letting or whatever is in vogue) is how they operate.
Some schools are beginning to integrate actual "therapy" more into their residents' training, but not all.

A Psychologist may or may not achieve a PhD (Doctor of philosophy), but will have a Masters Degree in Clinical Counseling (or be interning under the supervision of one toward that degree). They are NOT ALLOWED to prescribe. They work as therapists on the behavioral level, and are trained to see themselves, again, as EXPERTS treating a sick PATIENT.

Then there are Clinical Social Workers, who also may or may not achieve a PhD, but will have a Masters Degree in Clinical Counseling equal in credentials to the above Psychologist, and also are NOT ALLOWED to prescribe. Their style is different from Psychologists, though. The Social Worker is trained to build a rapport with the CLIENT (as opposed to "patient"), and to hold that the CLIENT is the EXPERT on their own lives, and are capable of DETERMINING THEIR OWN GOALS. Their job is to help the client determine and achieve those goals, not to treat them as "sick".

So, whether you're seeing an intern, a PhD, or a MSW, they will ALL have a partnering PSYCHIATRIST who is often itinerant and sees clients periodically to adjust prescriptions. The docs rely on the clinicians to keep them up to speed on progress in the behavioral aspects. And ALL THREE types of practitioners USE THE DSM, for billing purposes and uniformity of communication.

EVERY PERSON ON EARTH has moments or spells or days, or even years, of uncomfortable moods, emotions, thoughts, etc. EVERYONE can benefit from a professional screening or conversation. It is empowering if done well, and can be devastating if done poorly. Nevertheless, prescriptions are various. Some are short-term to alleviate symptoms until firmer footing is found by the client. Others are long-term to "correct" unusual bio-chemical imbalances. Without THERAPY, though, scrips alone often will do little.

Finally: The DSM is a DIAGNOSTIC TOOL only. Its purpose is to give CODE numbers for BILLING to INSURANCE. While it has a lot of stats and lists of "clusters of behaviors", it is NOT A CURE HANDBOOK. It's your practitioner's skill that makes the difference.

Anyway, just wanted to pitch in here.

reply to post by Wertdagf


I understand your point, and maybe you're right about stabilization. But in many cases the medication is given as a permanent solution.

And the list was written by a professional psychiatrist. Believe me, I have a ton of respect for mental health workers. I just think we are on a slippery slope of over diagnosing and over medicating.

reply to post by watchitburn


This is paranoid thinking, friend. The government regulates the healing arts to some extent, but it's to protect the consumer and enforce ethical conduct (a whole different subject). Normally operates at state level, though.

Again, the DSM is simply a list of CODE NUMBERS to differentiate between types of problems. As more people access mental health services, the need for more delineation of problems - more specificity - grows. Some conditions warrant only brief treatment in an out-patient setting, and others require life-long support.

Also, the DSM has 5 axes of diagnosis; it's a complicated thing to arrive at a code number. Every person is different.

reply to post by wildtimes


Thank you so much for that.

I think that "art" aspect of mental therapy may be getting lost on some. This art is one that generally requires an intimate relationship with the patient, and a lot of the time the diagnosis is made by someone at a crisis center in their first meeting. I would love to see more people have a working relationship with mental health professionals from a young age, similar to pediatrics. That way the whole thing isn't so foreign when there is an issue.

Also, in in-patient treatment, the nurses play a huge role. In my experience, they were outstanding. It is worth noting that the support staff of the professionals is just as important to a successful treatment.

reply to post by PatrickGarrow17


Think that we are progessing so fast that these mistakes or misdiagnosisies will be corrected, IF there were any.

We are going to solve these problems pretty soon. There really isnt a reason to worry.

reply to post by Wertdagf


I'm very optimistic about our future as well. I think mental health is an area that needs to be addressed as we reform our society and culture.

Diet and unhealthy physical lifestyles are discussed ad nauseam, but we don't see enough discussion on promoting healthy mental lifestyles. That is the bigger part of the equation than illness treatment, because if we had a healthier mental culture than rates of illness would go down.

Similar to if we had a culture of healthy diet and exercise, diabetes and heart disease would go down.

It's a self feeding cycle. People live in an unhealthy way, and then go to get treatment which is gladly provided. There should be a shift toward healthy lifestyles, preventative health care, and treatment that encourages people to live in a way where they can be self-sufficient if possible.

reply to post by PatrickGarrow17

I'm always glad to help lay-people understand how the field of mental health operates! My pleasure!

I try to emphasize "goodness of fit" as the paramount objective. If you don't trust, or like, your clinician, you won't have as good an outcome. For every one of those "Codes" in the DSM, there are numerous ways to approach the treatment of them. It's the clinician's job to devise a treatment program; that's where the art comes in.

Being accessible, warm, honestly concerned, and making the client feel safe, validated, and cared for are the most important parts of it.

reply to post by PatrickGarrow17


The problem is generic diagnosis. You go to the local GP and if they're anything like my old one, they'd sooner give you a box of zoloft and some valium than actually give a toss about you. Unless in the Merck index it states that giving me something will cause me a stroke. Then they tend to hold off a little while. Wait for the blood pressure meds to kick in.

IE; useless as tits on a bull.

Now I've seen what a GOOD p.doc will do. Someone who knows about mental configurations other than 'happy joe' and his family of sport stars..

And they know more about how various treatments can vary, and discussing WITH the patient they can ascertain if something is working or if it needs tweaking. I spent about 2 months almost manic every day, which made me drink to the high heavens -- and I only ever drink to wake up or go to bed, so this was off the chart.

Dose check, and it's like a new world.

And somehow while having proper diagnosis (after almost god damn 15 years) and with proper sessions with rehab, I have nothing but praise for the understaffed, underfunded non-profit organisation who go out of their way above and beyond the expectations listed on the bits of paper.. makes any governemnt funded organisations down here look like .. well government funded organisations.. 15 closed queues, one full line of people and a sign "Gone to lunch".

What the common doctor throws at people should be a crime. It's absolutely no different than going to a bottle shop and the guy behind the counter selling you methylated spirits.

Not only that, but the slimey criminal closed the practice and took my personal records with him, with a $30 fee to have them sent back to the NEW clinic.

bloody cheek of the sod.

Oh.. but yeah, no more mania!!! now it's just meandering disinterest and inability to shut up...

reply to post by wildtimes


That may be,
But it doesn't mean the Govt. isn't taking advantage of the opportunity.

It seems to me, that people are seeking treatment, validation, consolation whatever you want to call it. For every thought they have or every event that they experience.

It's called life, and it's mostly not fair. Certainly it is not kind to the weak minded or the faint of heart. They need to suck it up and move on.

But no, we are seeing more and more people forking out tons of money to get doped up, recieve a pat on the ass and told that everything is going to be OK and it's their parents fault.

Why anyone would let another human tell them what's wrong with them and how they should be, is beyond me.
Anyone who makes it their job to dig into someone else's head and pass judgement or determine fitness is probably on some nefarious power kick.

These are just my opinions.

reply to post by watchitburn

It's called life, and it's mostly not fair. Certainly it is not kind to the weak minded or the faint of heart. They need to suck it up and move on.

But no, we are seeing more and more people forking out tons of money to get doped up, recieve a pat on the ass and told that everything is going to be OK and it's their parents fault.

Why anyone would let another human tell them what's wrong with them and how they should be, is beyond me.
Anyone who makes it their job to dig into someone else's head and pass judgement or determine fitness is probably on some nefarious power kick.

These are just my opinions.

Your "opinions" appear to be founded on misperceptions and arrogance.

Some people can't "suck it up", that's the whole point!
If you don't believe in counseling, that's fine...up to you. With that attitude, it woudn't work anyway. Still, I've noticed you posting about what a "wreck" you are in the wake of a relationship that hurt you.....
how's that "sucking it up" going for you?

You seem angry, unhappy, bitter, and oppositional. Your descriptoin of "why anyone would let another human tell them what's wrong with them and how they should be" also shows me you didn't read the post describing the various STYLES of COUNSELING.

But, whatever. Congratulations for promulgating an ignorance of the value of humans helping their fellow humans to feel better and function more productively. I made the huge mistake of marrying a guy with your same attitude while I was in grad school, actually! I ignored the red flag that he was dissing my chosen course of study even while we were dating -- needless to say, the relationship was a huge disaster, and I threw him out within three years of our "marriage".

He was what he called a "chameleon" - with no solid sense of "self", and piss-poor communication skills as well as outrageous expectations of how others should "interpret" him without him "communicating" to them. He went on to totally take advantage of my kindness and supportive nature, ruined my credit, and stole a bunch of what was mine. He was what I call a sociopathic narcissist with immature and self-centered, childish behavior who would "pretend" to be whatever to get people to "engage" with him. No solid, honorable sense at all.

He's still a mess, but found another who fell for his crap. Go figure! Takes all kinds, my friend. Good luck to you.

Just my opinion.

reply to post by wildtimes


What are your thoughts on the changes in the DSM expanding the criteria for diagnosis?

The psychiatrist that wrote the article in the OP viewed the changes very negatively, and I tend to agree that there is a trend toward classifying normal problems as mental illness.

reply to post by PatrickGarrow17


The DSM is a controversial tool in the profession to begin with. That's why I emphasized it is a Coding System for billing purposes only.

Normal life is confusing; and as we learn more about human thought, behavior, and social functioning, more subsets of "problems" arise. The DSM also gets updated as newer theories and newer statistical information comes to light through research and practice and outcomes measurements.

There is not ONE PERSON alive who functions at 100% perfection. The last of the 5 measurement tools is the Global Functioning Assessment. On a scale of 0-100, a person's behavior and interactions with others and their circumstances is measured. 100 is "unattainable perfection"; and 0 is "DEAD".

Factors considered include physical health, circumstantial difficulties, general behavioral reactions to common problems, and bona-fide "mental illnesses" which are psychoses. The DSM is not a tool to "label" everyone as "mentally ill." That is only one of the Axes of assessment. All 5 Axes have to be considered before a Code can be chosen, and much of it is based on the client's reported, subjective view of the world.

Just because someone is enduring grief does not make them "mentally ill." The most common dx is "adjustment disorder", that is, having trouble "sucking it up" and coping with a crisis (whether acute due to trauma or life-events, or chronic discomfort and poor ability to function in general.)

No DSM will be considered perfect. They are compiled by a panel of people, and are subject to change, much like treatments for cancer, back pain, etc. Medicine is a fluid art, and as more people access the system, more is learned about the psyche and functioning.

I haven't looked at it yet, but the DSM-5 is bound to upset some professionals who are firmly embedded in theory. Again, it's only a coding tool, not the Truth. We don't know enough yet about the brain and mind to have it all sorted.
What worries me is that people want to label anyone as "mentally ill" who seeks help from another. That's not the point of the manual. It is just a reflection of current knowledge and the "presenting" problems that lead to people seeking or receiving help.