Making the DSM-5 by Joel Paris & James Phillips

Author:Joel Paris & James Phillips
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Conclusion

The dreams of a paradigm shift that motivated the DSM-5 revision process have largely been discarded. The Task Force, scrambling to meet its May 2013 deadline, has little time to address the Assembly motion. In an attempt to save face, it is now proffering the notion that the DSM will become a “living document”—rather than having a periodic wholesale revision the manual will be revised incrementally as needs arise—as the true innovation. But given that the details of how this would be achieved have not been laid out, it is clear that the promotion of the idea of a “living document” represents little more than the Task Force trying to whitewash what has been a disastrous process.

So what can we expect from the DSM-5? First, despite all its problems, the manual will likely be a financial success. Although the actual text might not represent much of a change and/or improvement over DSM-IV, because the DSM has become so central to mental health practice people will buy it. But they will not be buying a game changing document. The grouping of some disorders is slated to change, as will criteria for specific categories. But there is no revolution here. The categorical system will remain intact, although the text of some of the definitions will incorporate more dimensional language. Only time will tell whether the ­perennial concerns with the DSM—overmedicalization, diagnostic expansion, and proliferation of disorders—will worsen or improve in the new manual.

Whatever the final product looks like, the manual’s status as a source of professional prestige has been compromised. While it is far too early to assess the implications of the public debate, the Assembly’s retreat and the internal bad blood that the process has created have damaged psychiatry’s professional standing. We seem to be witnessing the limits of the strategy of shoring up professional jurisdiction through taxonomic revisions. The DSM-5 tried, but failed, to repeat Spitzer’s feat. Certainly the lessons from this revision will make future task forces (if there are any) squeamish in trying to use the DSM to achieve paradigm shift.

The DSM purports to be many different things at once. According to the DSM-­IV-TR [48]: The utility and credibility of DSM-IV require that it focus on its clinical, research, and educational purposes and be supported by an extensive empirical foundation. Our highest priority has been to provide a helpful guide to clinical practice. We hoped to make DSM-IV practical and useful for clinicians by striving for brevity of criteria sets, clarity of language, and explicit statements of the constructs embodied in the diagnostic criteria. An additional goal was to facilitate research and improve communication among clinicians and researchers. We were also mindful of the use of DSM-IV for improving the collection of clinical information and as an educational tool for teaching psychopathology (emphasis added).

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