Discussion of the DSM

Power still has its limits

It seems in this day and age that almost everything you do or don’t do can be labeled with a diagnosis. The DSM (diagnostic and statistical manual of mental disorders) is full of them. It is growing bigger all the time. If you eat too much chocolate you are a chocoholic. If a child is too antsy or hyper they are said to have ADHD (attention deficit/ hyperactivity disorder). If there is a lack of focus or concentration then you must have ADD (attention deficit disorder). True it is comforting to have a name for what you or your child could be suffering from. However, once a person is labeled others tend to not see the real person inside anymore. They are now just a walking personality problem or mental case. There can be confusion of serious mental disorders with normal everyday problems. These are a couple of the DSM’s drawbacks. In the following, I will discuss four of DSM’s limitations and the powerful role it plays in our society.

Since 1952 the DSM (Diagnostic and Statistical manual of mental disorders) has been assisting clinicians and researchers in diagnosing mental disorders. Its primary goal is to provide clear diagnostic categories for the treatment and study of these ailments. (American Psychiatric Association, 1994, 2000) The DSM lists the symptoms of each disorder. It also provides information about the typical age onset, predisposing factors, course of the disorder, prevalence, sex ratio of the affected, and the cultural issues that may affect the diagnosis. (Wade and Tavris, 2008) The first edition was only 86 pages and included 100 diagnoses. Currently the fourth edition published in 1994 (revised in 2000) includes 900 pages and almost 400 diagnoses. We are still awaiting yet a fifth edition expected to be published in 2013. (www.dsm5.org) The DSM has had a major impact worldwide. Nearly all psychiatry and psychology textbooks base their discussions of mental disorders on the DSM. Also, despite a warning from the DSM that its categories may not be wholly relevant to legal judgments, attorneys and judges still refer to this manual.

Generally every powerful influence comes with its limitations. Critics maintain it is important to be aware of said “limitations” of the DSM. In regards to the DSM’s classification and labeling there exist four. The first limitation we should be aware of is the danger of over diagnosis. A prime example can be seen in diagnosing young children with ADHD. This is especially seen with boys. They make up 80-90 percent diagnosed in this group. It could be argued that both boys and girls can tend to be a little overactive at times and still be normal. (Panksepp, 1998) It appears in some cases, it is easier to deal with the behavior by slapping a diagnostic label on the child and administering drugs. In my opinion this is neither healthy nor correct.

This brings us to the next possible drawback; the power of the diagnostic label. As parents of hyperactive or oppositional children, we become frustrated. We want to find out why our child is acting out. Maybe the problem isn’t our children but our self having a potential disorder. Either way it is human nature to want to know what is causing the problem. It is comforting to finally have a doctor say,” I know what you or your child has”. Once labeled though, we tend to “stand out from society” so to speak. Others want to judge us or our children by the “label of the disorder” instead of who we really are or why we have the ailment in the first place. This can have a major impact on a child or an adults self esteem and social life.

In life there are everyday problems we all have to face. Sometimes we may not know how to handle these issues. We may resort to over using caffeine for lack of sleep. Due to stress we might have a problem expressing ourselves clearly in speech or writing. Does that mean we have a true mental disorder? Each new addition of the DSM has added more everyday problems. Labeling such normal life issues has brought about serious confusion of mental disorders with normal problems. Hence, this brings about the third setback of the DSM. (Houts, 2002)

The fourth limitation of the DSM is said to be the illusion of objectivity and universality. In other words, many decisions about what to include as a disorder are based not on empirical evidence but on a group consensus. Group conclusions often bring about prejudice and prevailing attitudes rather that objective evidence. (Kutchins & Kirk, 1997; Tiefer, 2004) Through the years many psychiatrists have rejected some of the disorders lacking verifiable scientific experimentation. Homosexuality and childhood masturbation disorder are among these disorders. (Wakefield, 1992) Whatever the possible disorder in question may be, all aspects surrounding the behavior should be considered. There should not only be objective scientific validation, but also research of the cultural dynamics of the problem.

Even with its limitations, critics agree that the DSM is still a powerful and useful asset in assisting with diagnosing mental disorders. When used properly the DSM improves the reliability of the diagnostic process. This in turn assists clinicians with administering an appropriate treatment plan. In some aspects it appears that science has possibly gone too far in its research and dissection of people’s mental anguishes. To some, it possibly has even become a hindrance. However, without the trial and errors in the study of psychology, the majority of people today would not be able to live happy healthier lives.


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