DSMphobia?

After another wave on my facebook feed of shared articles expressing concern, derision, and even outright fear over the diagnostic criteria given in the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition, I feel the need to write a little something here.

The DSM is essentially not much more than a means of linking a set of pathological traits with a shorthand definition. This can be useful when communicating between different health professionals or to health insurance companies, and when gathering statistics and conducting research on mental illness. It doesn’t generate new diseases, really, just labels to quickly describe observed illnesses.

The DSM itself explains that for something to be a mental illness, well, it has to cause illness — it needs to be “associated with present distress[…]or disability[…]or with a significant increased risk of suffering.”

Over- and misdiagnosis of mental illnesses is a legitimate concern, but so is misunderstanding and dismissal of mental illness.

One particular case which leaps to mind is a breathless article I stumble d across about oppositional defiant disorder (ODD) and its inclusion in the DSM-5. It appears to be one of several rehashes of a 2010 article about ODD in the DSM-IV, which seemed to completely fail to realise that ODD in fact first appeared in the third edition of the DSM. The thrust of the article was that the American Psychiatric Association had declared free thinking and non-cornformity a mental illness.

ODD is a childhood disorder characterised by irrational extreme behavious such as abnormal and violent contrariness and defiance, blaming and punishing others for their own mistakes, spite and vengefulness, and deliberate inflammatory behaviour, taken to an point where it causes significant problems to the life of the child and those around them. Treatment typically involves training the parents and carers in management techniques, and family therapy. (Not drugs. Not locking anyone up.)

The various articles published around the web declaring that free thinking and nonconformity have been pathologised appear to have become confused thanks to incomplete information.

ODD is a childhood disorder, and the described features are based on the social environment and mental development level of a child, not an adult. An adult cannot have ODD. If they are having problems that seem similar, they might have an adult personality disorder.

General misbehaviour and considered objection to authority is not ODD. ODD is an irrational anger-driven disorder which causes serious family, social, and/or academic problems. It falls far outside of the normal range of pushing boundaries and challenging authority that a child or teenager may display. It is an extreme behaviour pattern.

The same applies to most of the various other panicked essays written about illnesses included in the DSM. Concern about whether it is appropriate to label something a mental illness is valid, absolutely! However, usually these concerns are based on incomplete information, commonly incomplete and misunderstood criteria that must be met to apply the label of that disease, or a misunderstanding of the degree of morbidity required for a normal general or psychiatric health professional to actually call something a disease, disorder, or illness and recommend treatment.

Over-diagnosis and pathologising of normal behaviours are legitimate concerns. Yes, inclusion in the DSM or ICD increases awareness of the disorder and may lead to over- or incorrect diagnosis. Yes, diagnoses of mental illness have been used as a method of controlling dissenters in authoritarian regimes. Yes, vigilance is generally valid and wise… but care must first be taken to make sure that you are in fact talking about what you think you’re talking about.

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