The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum Disorder. This (...) opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

La psiquiatría a lo largo de su historia y fundamentalmente desde la publicación del DSM-5, enfrenta diversas críticas por la falta de confiabilidad y validez en las clasificaciones de los trastornos mentales, esto debido a su incapacidad para integrar adecuadamente el conocimiento científico y la complejidad de las experiencias individuales. Este análisis, inspirado en la filosofía de Hegel, propone una nueva perspectiva que valora cada caso clínico como una entidad única, desafiando el enfoque reduccionista y promoviendo un entendimiento más profundo (...) y respetuoso de la psicopatología, enriquecido con una integración dialéctica del conocimiento científico y el concepto del universal concreto. (shrink)

For millennia, diagnosticians distinguished natural sadness that arose from social circumstances from depressive disorders that were disproportionate to their contexts. In 1980, the DSM-III transformed this tradition through equating depressive disorders with symptoms without regard to context. Nevertheless, it excluded grieving people without especially severe or enduring symptoms from diagnosis. Subsequently, considerable empirical research indicated that bereavement was not unique but a model for all stressor-maintained conditions. Yet, despite the evidence showing that the causes, prognoses, and optimal treatments for context-specific (...) depressions differ from those that aren’t, the DSM-5 removed the bereavement exclusion from the diagnostic criteria for major depression. This article considers the reasons behind this elimination and its implications for the research, labeling, and treatment of depression. (shrink)

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic (...) categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

The development of the fifth edition of the American Psychiatric Association9s _Diagnostic and Statistical Manual of Mental Disorders_—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate (...) around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance. (shrink)

At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a certain extent, for diagnosis, is the DSM, now at its fifth edition. The main reasons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative failure of the project of finding biomarkers for most mental disorders. Descriptivism has also the advantage of (...) capturing the phenomenology of mental disorders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descriptive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (shrink)

Emil Kraepelin's nosology has been reinvented, for better or worse. In the United States, the rise of the neo-Kraepelinian nosology of DSM-III resuscitated Kraepelin's work but also differed from many of his ideas, especially his overtly biological ontology. This neo-Kraepelinian system has led to concerns regarding overdiagnosis of psychiatric syndromes (.

This paper offers an analysis of the DSM validation method, focusing on the role that non-empirical factors play in resolving forms of indeterminacy that cannot be settled by validator evidence alone. It begins by reconstructing the historical development and institutionalization of the DSM validation method, showing that although it emerged as an attempt to ground the classification of mental disorders in empirical evidence rather than in a priori preconceptions or contextual influences, it nonetheless came to rely on extra-empirical considerations at (...) several crucial stages and was, in its very design, shaped by them.The paper addresses this tension by drawing on the concept of a decision point developed in the literature on science and values. By identifying a series of decision points that arise both in the application of the validation method to particular diagnostic categories and in the process of designing and developing the method itself, it argues that the incorporation of value judgments and metaphysical presuppositions constitutes a necessary and epistemically pertinent element that enabled the validation method to take shape and, when applied to specific categories, allows the validation process to move beyond its initial stages and reach a determinate conclusion. (shrink)

The development and publication of Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) produced a peak in mainstream media interest in psychiatry, and a large and generally critical set of scientific commentaries. The coverage has focused mainly on the expansion of some categories, and loosening of some criteria, which together may lead to more people receiving diagnoses, and accompanying accusations of the medicalisation of normal living. Instructions given to members of DSM-5 work groups appear to have encouraged this.1 (...) This has not been the only source of disquiet. The influence of the pharmaceutical industry on the members of the appointees to DSM diagnostic work groups, which constructed the new rubrics, has caused concern,2 as remuneration and insurance coverage in the USA depends partly on DSM diagnosis, and the pharmaceutical industry has been accused of encouraging the development of new diagnoses as a way to increase profitability.3 Societal impact has been an explicit part of the development of DSM-5, as outlined in the article in this issue.4 Reasons for decisions by DSM-5 workgroups have included enabling sufferers to receive treatment which would not be available without a DSM diagnosis (a local US concern), or …. (shrink)

The DSM-V supports a medical culture that can be argued to undermine the importance of context for understanding problems of living. This paper will look at three components in relation to DSM-V’s biological model to show how they exacerbate the promotion of medication treatment using the examples of obsessive compulsive disorder, social phobias, anorexia, and the therapy experience of U.S. military troops. First, it will look at the DSM-V’s categorical approach to diagnosis in juxtaposition to a dimensional/holistic approach, framing the (...) former as an exacerbator of medical solutions to problems of living. Second, it will show that the abstraction required for the categorization inherent in the DSM-V does not rely on etiology, rather descriptions which lead to the discrete groupings of disorders for medical matchmaking. Finally, this paper will inform of the repercussions the DSM-V’s categorization and abstraction has on the interpretation of culture in relation to problems of living and why its stigmatization of such problems is an interpretation that contributes to the medicalization of treatment rather than a culture of commitment that incorporates holistic support. (shrink)

The authors discuss some of the conceptual issues that must be considered in using and understanding psychiatric classification. DSM-IV is a practical and common sense nosology of psychiatric disorders that is intended to improve communication in clinical practice and in research studies. DSM-IV has no philosophic pretensions but does raise many philosphical questions. This paper describes the development of DSM-IV and the way in which it addresses a number of philosophic issues: nominalism vs. realism, epistemology in science, the mind/body dichotomy, (...) the definition of mental disorders, and dimensional vs. categorical classification. (shrink)

Abstract: At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a cer- tain extent, for diagnosis, is the DSM, now at its fifth edition. The main rea- sons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative fail- ure of the project of finding biomarkers for most mental disorders. Descrip- tivism (...) has also the advantage of capturing the phenomenology of mental dis- orders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descrip- tive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (shrink)

This article begins with arguments evident at the time of writing about the 5th revision of the Diagnostic and Statistical Manual of the American Psychiatric Association. The historical lineages of those arguments are international and not limited to the USA (the current focus in the DSM-5 controversy). The concern with psychiatric diagnosis both internationally and in the USA came to the fore at the end of the Second World War with the construction of the American Psychiatric Association’s Diagnostic and Statistical (...) Manual ( DSM-I) and the World Health Organization’s classification of ‘Diseases, Injuries and Causes of Death’ (ICD-6). However, the linkage between categories of morbidity, assumptions about natural biological categories and treatment specificity with ‘magic bullets’ emerged in the middle of the 19th century in physical medicine. This article explores the legitimacy of current psychiatric diagnoses in the light of that international, not national, history of medical knowledge. In conclusion it explores judgements about current cultural imperialism (at times made about US psychiatry) and an older picture of Eurocentrism, which is now being refracted in more recent globalizing knowledge-claims about mental disorder. (shrink)

In February 2010, the American Psychiatric Association (APA) launched their DSM-5 website with details about the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The APA invited “the general public” to review the draft diagnostic criteria and provide written comments and suggestions. This revision marks the first time the APA has solicited public review of their diagnostic manual. This article analyzes reported speech on the DSM-5 draft diagnostic criteria for the classification Posttraumatic Stress (...) Disorder. It demonstrates how textual standardization facilitates the cultural portability of the DSM-5 diagnostic criteria such that a community of speakers beyond the borders of the APA come to be seen as exemplary speakers, writers, and revisers of the professional style. Furthermore, analysis shows how co-authoring practices recontextualize the “voice” and persona of putative patient reported speech on Criterion D2. As a consequence of textual standardization, spoken discourse becomes recontextualized as the product of scientific inquiry and the organization of psychiatric knowledge. (shrink)

Increasingly, scholars and advocates are recognizing the importance of including individuals with lived experience of mental health issues in the development of psychiatric research and policy. Here, we hope to contribute to discussions regarding the specific context of the Diagnostic and Statistical Manual of Mental Disorders (DSM) revision process. We argue that this process is not inclusive enough, but also that those who have advocated for better inclusivity have not been responsive enough to the risks reported from other inclusive mental (...) health contexts (in research, practice, and policy). In particular, tokenism and lack of uptake of input from people with lived experience are likely to loom large in relation to DSM efforts at inclusivity as well. In light of this, we suggest that disentangling the reasons for inclusion can help to overcome these problems, and we offer practical recommendations for a more inclusive DSM revision process. (shrink)

The DSM is the main classification of mental disorders used by psychiatrists in the United States and, increasingly, around the world. Although widely used, the DSM has come in for fierce criticism, with many commentators believing it to be conceptually flawed in a variety of ways. This paper assesses some of these philosophical worries. The first half of the paper asks whether the project of constructing a classification of mental disorders that ‘cuts nature at the joints’ makes sense. What is (...) mental disorder? Are types of mental disorder natural kinds (that is, are the distinctions between them objective and of fundamental theoretical importance, as are, say, the distinctions between the chemical elements)? The second half of the paper addresses epistemic worries. Even if types of mental disorder are natural kinds there may be reason to doubt that the DSM will come to reflect their natural structure. In particular, I examine the extent to which the DSM is theory-laden, and look at how it has been shaped by social and financial factors. Ultimately, I conclude that although the DSM is of immense practical importance it is not likely to become the best possible classification of mental disorders. (shrink)

While often dubbed “the bible of contemporary psychiatry” and widely hailed as providing “a benchmark” for the profession, on closer inspection the DSM is seen to be shot through with philosophical assumptions that restrict its theoretical cogency and limit it clinical efficacy. Hence, in the interests of enhanced patient-care it is important to think critically about the DSM, with a view to maximising its diagnostic strengths while minimising its weaknesses. The critical analysis undertaken in the present paper underscores the importance (...) of not construing the DSM as a self-contained diagnostic tool but of viewing it, rather, as an indispensable component in a more comprehensive, multidimensional diagnostic process. More specifically, the contention is that the DSM’s diagnostic limitations evoke a biopsychosocial framework of application as their necessary corrective, notwithstanding the entrenched tendency to construe these approaches as oppositional. Further, it is contended that a hermeneutically informed biopsychosocial template has particular advantages as an integrating framework. (shrink)

This article analyzes the historical evolution of ADHD and its close relationship with the use of psychostimulants, showing how diagnostic changes, clinical evidence, and social pressures have shaped their contemporary understanding. Although stimulants reduce symptoms and risks associated with ADHD, their neurobiological basis remains uncertain, and diagnostic expansion has led to overdiagnosis and medicalization. Non-medical, especially in educational and work context, highlights a central bioethical dilemma: the growing blurring between treatment and performance optimization. Epistemic critiques of clinical trials, the influence (...) of the pharmaceutical industry, the identity effects of diagnosis, and the tensions between autonomy, justice, and care are examined. The article proposes strengthening institutional ethics that limit commercial interests, ensure transparency in diagnostic construction, and promote a broader understanding of attention disorders, integrating biological, social, and cultural dimensions. (shrink)

The author of this paper discusses why the issue of financial conflicts of interest (FCOI) in psychiatry has important public health implications for women and why FCOI complicate the informed consent process. For example, when psychiatric diagnostic and treatment guidelines are unduly influenced by industry, informed consent becomes a critical issue, because women may be assigned diagnostic labels that are not valid and may also be receiving imbalanced or even inaccurate information about their mental health treatment options. However, mere disclosure (...) of industry relationships is an insufficient solution. Following Ells (2003), the author offers a more robust account of autonomy, inspired by Foucault, to strengthen informed consent practices. In addition to addressing power relations, this Foucauldian account of autonomy emphasizes the relational and dialogical aspect of the physician–patient relationship. (shrink)

This paper addresses philosophical issues concerning whether mental disorders are natural kinds and how the DSM should classify mental disorders. I argue that some mental disorders (e.g., schizophrenia, depression) are natural kinds in the sense that they are natural classes constituted by a set of stable biological mechanisms. I subsequently argue that a theoretical and causal approach to classification would provide a superior method for classifying natural kinds than the purely descriptive approach adopted by the DSM since DSM-III. My argument (...) suggests that the DSM should classify natural kinds in order to provide predictively useful (i.e., projectable) diagnostic categories and that a causal approach to classification would provide a more promising method for formulating valid diagnostic categories. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders. It is published by the American Psychiatric Association and revised by committee every 15 years or so. This chapter considers the DSM as a ‘conceptual building site’. I suggest that in the same way that structural engineers visit building sites to develop their understanding of the possibilities and limitations of designs and materials, conceptual engineers too can benefit from looking at the sites in which concepts (...) are created and refined. Looking at real-life processes of concept revision can enrich our understanding of what the conceptual engineer can achieve and where conceptual engineering might be difficult. (shrink)

I argue that there is only one way to interpret our current mental health diagnostic manuals: constitutively. I do so by showing that the only other way to interpret our manuals fails to meet the stated aims of the manuals themselves. Then I show that the constitutive position is the conceptual root of the reification problem by walking through the various attempts to provide validating mechanisms for existing diagnostic categories. In taking up this position, I argue that accounts that attempt (...) to validate mental disorders using either biological or social mechanisms ultimately fail because they either also violate the aims of our diagnostic manuals or themselves fall prey to the reification problem. Furthermore, I show that the problem for validation—the problem of reification—persists in our best accounts precisely because we must take the constitutive interpretation of our diagnostic manuals. (shrink)

El DSM, elaborado por la Asociación de Psiquiatría Americana (APA), es la clasificación de los trastornos mentales más relevante del ámbito académico y clínico. Se trata de un manual que ha ido cambiando con su contexto, pero sus modificaciones no siempre han respondido a avances en el conocimiento científico. El repaso histórico de sus sucesivas ediciones muestra su naturaleza sociopolítica, y que factores de tipo ideológico o político han tenido gran relevancia en su configuración. Estos factores ayudan a explicar las (...) propiedades de la psiquiatría actual que el DSM-5 representa, y a comprender las fuertes críticas que se le dirigen. (shrink)

Moral considerations do not appear to play a large role in discussions of the DSM-IV personality disorders and debates about their empirical validity. Yet philosophical analysis reveals that the Cluster B personality disorders, in particular, may in fact be moral rather than clinical conditions. This finding has serious consequences for how they should be treated and by whom.

his article develops a set of recommendations for the psychiatric and medical community in the treatment of mental disorders in response to the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, DSM-5. We focus primarily on the limitations of the DSM-5 in its individuation of Complicated Grief, which can be diagnosed as Major Depression under its new criteria, and Post-Traumatic Stress Disorder (PTSD). We argue that the hyponarrativity of the descriptions of these disorders (...) in the DSM-5, defined as the abstraction of the illness categories from the particular life contingencies and personal identity of the patient (e.g., age, race, gender, socio-economic status), constrains the DSM-5's usefulness in the development of psychotherapeutic approaches in the treatment of mental disorders. While the DSM-5 is useful in some scientific and administrative contexts, the DSM's hyponarrativity is problematic, we argue, given that the DSMs are designed to be useful guides for not only scientific research, but also for the education of medical practitioners and for treatment development. our goal therefore is to offer suggestions for mental health practitioners in using the DSM-5, so that they can avoid or eliminate the problems that may stem from the limitations of hyponarrativity. When such problems are eliminated, we believe that effective psychotherapeutic strategies can be developed, which would be successful in repairing the very relationships that are strained in mental disorder: the patient's relationship to herself, her physical environment, and her social environment. (shrink)

This chapter examines philosophical issues surrounding the classification of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, the chapter focuses on issues concerning the relative merits of descriptive versus theoretical approaches to psychiatric classification and whether the DSM should classify natural kinds. These issues are presented with reference to the history of the DSM, which has been published regularly by the American Psychiatric Association since 1952 and is currently in its fifth edition. While the (...) first two editions of the DSM adopted a theoretical (psychoanalytic) and etiological approach to classification, subsequent editions of the DSM have adopted an atheoretical and purely descriptive (“neo-Kraepelinian”) approach. It is argued that largest problem with the DSM at present—viz., its failure to provide valid diagnostic categories—is directly related to the purely descriptive methodology championed by the DSM since the third edition of the DSM. In light of this problem, the chapter discusses the prospects of a theoretical and causal approach to psychiatric classification and critically examines the assumption that the DSM should classify natural kinds. (shrink)

How does Ricœurian film hermeneutics relate to the practical task of interpreting Dog Star Man? What is the process through which the interpretation of Dog Star Man’s film world can be developed? Based on the Ricœurian dialectics between understanding and explanation, this chapter describes the three phases and the related stages of the hermeneutic method that will be applied in the interpretation of the film. Starting with an initial guess about the film’s meaning, the method identifies an interpretive process that (...) evolves from a first understanding, and moves on through explanation, to arrive at a critical understanding of the film world. In this methodological framework, Dog Star Man, a masterpiece of experimental cinema created by film craftsman Stan Brakhage as a silent metaphor of vision, appears from the outset to be a challenging case study for Ricœurian film hermeneutics. (shrink)

In this book authors for the first time introduce the notion of supermatrices of refined labels. Authors prove super row matrix of refined labels form a group under addition. However super row matrix of refined labels do not form a group under product; it only forms a semigroup under multiplication. In this book super column matrix of refined labels and m × n matrix of refined labels are introduced and studied.

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and (...) essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

Riassunto: In questo contributo analizzeremo il criterio del danno, presente nella definizione generale di disturbo mentale del DSM. La questione ha rilevanza sia da un punto di vista filosofico, perché il danno è una componente normativa e valoriale, non oggettiva, sia da un punto di vista clinico, perché chi ha difeso il criterio del danno ha spesso sostenuto che in sua assenza avremmo troppi falsi positivi. Infine, ha importanza dal punto di vista socio-sanitario in relazione al rapporto tra la psichiatria (...) e la medicina non psichiatrica, nello specifico tra il DSM e l’ICD. Sosterremo che ci sono buone ragioni per non mantenere il danno come criterio necessario nella definizione generale del disturbo mentale. Dopo una breve introduzione, forniremo una panoramica storica sul ruolo del criterio del danno nelle varie edizioni del DSM. Successivamente si illustrerà la principale obiezione contro l’inclusione del criterio del danno nella definizione generale di disturbo mentale, ossia il problema dei falsi negativi, per poi presentare e discutere ulteriori ragioni – medico-pratiche e concettuali – che depongono a sfavore dell’attribuzione di un forte peso al criterio del danno. In sede conclusiva ribadiamo come la decisione presa dalla task force del DSM-5 di escludere il criterio del danno dalla definizione generale di disturbo mentale debba essere sostenuta. Parole chiave: Danno; Disabilità; Disagio; Disturbo mentale; DSM “Harm” as Criterion for the Definition of Mental Disease in DSM. Some Epistemological Reflections: In this paper, we analyse the harm requirement in the general definition of mental disorder in the Diagnostic and Statistical Manual for Mental Disorders. This issue has both philosophical and clinical relevance: on the one hand the harm requirement is a normative, value-laden, non-objective component in the definition of mental disorder; on the other hand, the harm requirement has often been defended on the grounds that it prevents an increase in false positives. The issue is also important in assessing the relationship between psychiatry and somatic medicine, more precisely, between the DSM and the International Classification of Diseases. We argue that there are good reasons not to maintain the harm requirement in the general definition of mental disorder. After a brief introduction, we overview the history of the harm requirement across the various editions of the DSM. Then, we examine the main objection to the inclusion of the harm requirement in the general definition of mental disorder, that is, the problem of false negatives, and also present several other points – both practical and conceptual – that help demonstrate why the harm requirement is inadequate as a definiens of mental disorder. To conclude, we stress that the decision of the DSM-5 task force not to regard the harm requirement as a necessary component of mental disorder should be endorsed. Keywords: Harm; Disability, Distress; Mental Disorder; DSM. (shrink)

The introduction of the Diagnostic and statistical manual of mental disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview. Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of “construct validity” and “conceptual validity” and (...) a failure to distinguish between “disorder” and “non disordered conditions for which we help people.” The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to “degrees of severity” of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The WHO and APA recently converged on a shared way of characterising transgender people and the purpose of medical interventions like cross-sex hormone treatment and gender confirmation surgery. According to WHO’s ICD-11 and APA’s DSM-5, transgender people’s experienced gender is incongruent with their natal sex or natal gender, and the purpose of such medical interventions is to reduce that incongruence. However, I argue that although this ‘incongruence thesis’ (IT) may seem progressive, it is alas conceptually incoherent, insidiously regressive, and hostile (...) to diversity. (shrink)

The introduction of the Diagnostic and Statistical Manual of Mental Disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview. Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of "construct validity" and "conceptual validity" and (...) a failure to distinguish between "disorder" and "nondisordered conditions for which we help people." The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to "degrees of severity" of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders contains the official diagnostic criteria for recognized mental illnesses. Some have asserted that DSM revisions have caused the boundaries of specific disorders to expand to include more behaviors, but no previous research has examined if such expansion is isolated or endemic. The current research consisted of an exploration of revisions to diagnostic criteria for 81 disorders. Each change between editions of the DSM was conceptually analyzed as making the disorder more exclusive or (...) more inclusive in terms of the number of people who could theoretically meet the criteria. Results indicated that 63% of disorders moved toward inclusivity, that each edition of the DSM moved toward inclusivity, and that most types of revisions increase inclusivity. (shrink)

BackgroundThere is much overlap among the symptomology of autistic spectrum disorders, obsessive compulsive disorders, and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health.AimThis study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging.MethodologyThe data involved electrocardiogram heart rate variability and questionnaire data. In total, 1,089 participant's data of ECG recordings of healthy resting (...) state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale ; Toronto Alexithymia Scale 20 ; Acceptance and Action Questionnaire ; Depression, Anxiety, and Stress Scale 21 ; Multi-dimensional Assessment of Interoceptive Awareness Scale ; and the Self-as-Context Scale.ResultsHeart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception.ConclusionThe results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model. Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame. (shrink)

The stated purpose of the Diagnostic and Statistical Manual of Mental Disorders is to classify mental disorders. However, no tenable operational definition of mental disorder is offered in the manual. This leaves the possibility open that the behaviors labeled as disordered in the DSM are not members of a valid category. Attempts to define mental illness fall into the category of essentialist or relativist based, respectively, on the acceptance or denial of the existence of a defining biological attribute that all (...) mental disorders possess. However, the disorders in the DSM cannot be accounted for by either of these approaches making it unlikely that they represent a single valid concept. Simultaneous inclusion of brain illnesses and normal behaviors in the DSM are a likely explanation for the disparate nature of DSM disorders. (shrink)

Although the “Introduction” to the DSM makes it clear that the presence of “clinical” distress or impairment is insufficient for a diagnosis of “mental disorder” , in practice the clinician is completely unshackled from the conceptual definition and is free to decide on a case-by-case basis if “enough” distress or impairment is present, regardless of circumstances, to judge that “mental disorder” can be diagnosed. It is argued that reference to a biological or psychological dysfunction cannot raise “mental disorder” from a (...) judgment quite like “This is pornography, not literature” to a technical–scientific term because “biological dysfunction” must be tied to an outcome that is itself less ambiguous than “mental disorder,” and “psychological dysfunction” erroneously assumes that how people are supposed to think, feel, and act, regardless of circumstances, can be as uncontentious as ideas about physical well being, and in addition erroneously assumes that human behavior can be causally explained. (shrink)

Before we respond to Tamara Browne's proposal for an external ethics advisory review panel to oversee content in the Diagnostic and Statistical Manual of Mental Disorders, we wish to introduce ourselves. One of us is a professor of bioethics, a lawyer, and a doctor of public policy, and one of us is a philosopher of psychiatry who studies psychiatric nosology, and who has done bioethics work for two congressional advisory agencies. Based on our backgrounds, we flatter ourselves that we might (...) be considered as members of the DSM ethical review panel Browne proposes. However, we realize that one of us would likely be ineligible because of a lack of experience in psychiatry, and the other would... (shrink)

In 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of creating, validating, studying and employing a diagnostic system in clinical psychiatric practice was introduced. There have been several updates and revisions to this manual and, regardless of its a theoretical framework, it actually does have a framework and presupposition. Essentially the DSM dictates that all psychiatric disorders are syndromes, or a collection of symptoms that commonly occur together and impair psychosocial functioning. These syndromes allow for homogenous groups (...) of patients to be studied and psychotherapies and pharmacotherapies to be developed. This editorial will examine the DSM system with regards to its applicability to central nervous system dysfunction where psychiatric disorders are concerned. Specifically, the brain does not follow categorical, or syndromal, constructs. In fact, the psychiatric patient likely inherits several risk genes that promote abnormal proteins along several neuropathways in the brain. These abnormalities create dysfunctional neurocircuits which create individual psychiatric symptoms, but not a categorical syndrome or diagnosis. The concept that the DSM may be excellent for clinical diagnostic purposes, but less correct in its assumptions for a psychopharmacologist's treatment approaches will be discussed. (shrink)

Se aborda de forma crítica la exposición del desorden del espectro autista llevada a cabo en la quinta y última edición del Diagnostic and Statistical Manual of Mental Disorders (DSM-5), herramienta principal de muchos psiquiatras para comprender y diagnosticar cualquier psicopatología. Con este abordaje se busca evidenciar cómo, en el DSM-5 –al igual que en la interpretación inaugurada por Baron-Cohen, Leslie y Frith–, se deja de lado la experiencia y el cuerpo animado del paciente, por lo que es aconsejable un (...) nuevo acercamiento a dicho desorden que tenga fundamentos fenomenológicos. Finalmente, se presenta el bosquejo de una fenomenología del desorden del espectro autista que reconoce la primacía del cuerpo animado en la experiencia del mundo, de sí mismo y de los otros. (shrink)