Introduction
The diagnosis of mental disorders is based on the principles of good clinical practice, including objectivity and reliability of the diagnostic examination, which ensures comparability and reproducibility of diagnostic decisions by psychiatrists with different levels of professional training and work in different countries. Using classifications and guidelines as diagnostic standards reflects the professional community’s desire to identify patients’ disorders by clinical reality while minimizing the influence of subjective factors (Zimmermann et al., 2019). Overcoming subjectivity is particularly important in psychiatry, where methodologies based on subjective assessment are widespread.
In addition to standardization, diagnostic guidelines and classifications are aimed at controlling the epidemic situation, possible threats to public health, and assessment of disease severity, which allows the same disease to be assessed in different countries on different continents. The following directions are identifying risk groups among the population and vulnerability to certain diseases and the justification of providing free or partially paid medical care to the population at the state level. Equally important functions are to provide a basis for developing treatment standards, creating protocols and clinical guidelines and use for scientific purposes, and conducting research to find more effective treatments and clinical trials.
Historically, the U.S. uses the DSM, which is developed, updated, and implemented by the American Psychiatric Association (APA). The European countries use the ICD, whose adoption and updating is the prerogative of the World Health Organization (WHO). It should be noted that since 1982, the improvement and development of these two classification systems have been coordinated (Horwitz, 2021). Each of the classifications preserves the traditions of the national schools of psychiatry.
History of DSM
The history of the DSM is very interesting, as there have been several editions, and they have progressed and become more accurate. In 1952, the American Psychiatric Association published the DSM-I (Horwitz, 2021). This catalog of mental disorders had a theoretical basis in the views of the authoritative psychiatrist Adolph Meyer (Gonçalves et al., 2018). Meyer’s main idea, which influenced the DSM-I, had to do with a certain view of symptoms, treated not as external manifestations of some disturbance in the body’s biology but as a complex reaction to life circumstances. Nevertheless, the DSM-I was not subordinated to the influence of psychoanalysis. DSM-II is the successor of DSM-I as far as continuing the psychodynamic tradition is concerned. Indeed, the controversial term “neurosis” is still used in the new classification version (Leggatt, 2022). The word’s meaning, which predates psychoanalysis, has often changed and gradually become elusive to unequivocal understanding. At the same time, DSM-II takes a step away from the theoretical framework considered very important when DSM-I was drafted.
The drafters of DSM-III wanted to create an atheoretical document, a guide for practitioners who do not have time to delve into discussions about the etiology of diseases. Therein lies the revolutionary nature of the DSM-III. However, etiology was supposed to be the main validator for diagnosis. DSM-III has two validators: disease course and response to treatment. By early 2000, there was a need for a paradigm shift and a renewal of diagnostic philosophy (Le Moigne, 2018). However, it appears that by the time DSM-5 was published, the new paradigm had not yet matured. Science had not yet developed descriptions of the neurobiological factors underlying mental illness that could be used as criteria for classifying illnesses. As a result, the DSM-5 retained a categorical approach, although minor inclusions of a dimensional approach were allowed to organize the material in the chapters.
Is the DSM-5 the “Bible of Psychiatry”?
The DSM-5 cannot be regarded as the Bible but as a dictionary for psychiatrists. All indicators and symptoms are too individualized. Its main purpose is to provide verifiable, quantifiable criteria and a common language for physicians to communicate with patients and, perhaps most importantly, for physicians to communicate with insurance companies. It gives pharmaceutical firms a set of goals for developing their drugs, but none of this qualifies it as the Bible. It is intended to be revised as scientific understanding evolves. The current nomenclatural classifications are agnostic about etiology, although that should change as researchers better understand biological pathogenesis. Diagnoses in the DSM are based on consensus about groups of clinical symptoms without objective laboratory measurements.
This extremely important book does not give instructions but informs practice. It is more than just a guide for those conducting research. It is a specific vocabulary and collection of scales by which research on schizoaffective disorder results can be combined because they both denote the same thing and are evaluated similarly. Each of the editions has been reliable in that it has established that clinicians use the same terms in the same way, but the weakness has always been a lack of validity. The various updates published by the American Psychiatric Association that made up the Diagnostic and Statistical Manual of Mental Disorders versions have traditionally been subject to criticism and disagreement (Tolentino & Schmidt, 2018). Although each new publication has attempted to achieve a higher index of consensus among experts, the truth is that the existence of a sector of the professional psychology and psychiatry community cannot be denied.
The DSM requires a minimum number of criteria to be met (half plus one) but does not specify any as necessarily binding. More specifically, a great deal of correspondence has been found between schizotypal personality disorder and schizophrenia; paranoid personality disorder and delusional disorder; personality disorder and mood disorders, and obsessive-compulsive personality disorder and obsessive-compulsive disorder (Widiger & Crego, 2018). It is very difficult to distinguish between a continuum of marked personality traits (normality) and extreme and pathological personality traits (personality disorder). Even if one specifies that there must be a significant functional deterioration of personal and social personality indicators, as well as a manifestation of a stable psychological and behavioral repertoire over time of an inflexible and maladaptive nature, it is difficult and difficult to determine which population profiles fall into the first category or the second. In addition, concerning the consistency between the descriptions given for each personality disorder diagnosis, they do not maintain sufficient consistency with the features observed in clinical patients at the consultation and with overlapping clinical pictures that are overly broad.
- Diagnoses and their Implications for Culture-based Mental Illnesses from the DSM-5. Based on a review of the current neuroscience evidence base with clinical utility in mind, the DSM-5 highlights new disorders, chief among them: pathological hoarding, disruptive mood dysregulation disorder (DMDD); compulsive overeating; premenstrual dysphoric disorder; restless legs syndrome; and conduct disorder due to disruption of the rapid sleep phase (Sharp & Wall, 2021). It should be emphasized that the new disorders, on the one hand, improve diagnosis and, on the other, avoid the stigmatizing effect of psychiatric diagnosis (Miller et al., 2018). In the case of the growing population of bipolar disorders in childhood, there is an opportunity for clinicians in a particular clinical setting to move children with symptoms of persistent irritability and social disorder beyond bipolar disorders by including them in the DMDD group. The changes in the DSM-5 terms are aimed primarily at destigmatizing psychiatric diagnoses and at “mitigating” the psychological consequences that arise for patients and their environment after such diagnoses as “schizophrenia,” “mental retardation,” and “dementia.” The term “mental retardation” has been eliminated from the DSM-5 and replaced with “intellectual developmental disorder” (Amoretti & Lalumera, 2019). The term “dementia” has been replaced by “neurocognitive disorder,” and the term “substance use disorders and addiction” is used instead of “substance abuse” and “substance dependence. Since all sections of the DSM-5 transformed processing, describing the updated diagnostic criteria is lengthy. This article presents the changes in the diagnostic criteria for schizophrenia, bipolar disorder, and depressive disorder that are most commonly used in scientific developments and attract practitioners’ attention.
- Cultural Perceptions in DSM-5. The fifth version of the Diagnostic and Statistical Handbook of Mental Disorders integrates enhanced cultural awareness throughout the handbook to better care and diagnosis for persons of different ethnicities. DSM-5 is more than a catalog of culture-bound disorders as it upgrades criteria to recognize cross-cultural differences in presentation (Shorter, 2021). It also provides more structured information concerning cultural principles of distress. DSM-5 comprises a clinical interviewing tool to enhance thorough, person-centered analyses.
Symptoms manifest or are explained differently in different societies and cultures. As a result, doctors must be aware of crucial contextual information derived from the patient’s culture, ethnicity, or religion. Uncontrollable sobbing and migraines, for example, are signs of panic attacks in certain cultures, although trouble breathing could be the predominant symptom in others (DeSilva et al., 2018). Understanding such variances can assist professionals in more correctly diagnosing and treating issues.
The new guidebook discusses cultural distress ideas, including how various cultures explain symptoms. Cultural symptoms and explanations are used to characterize them. These ideas help physicians understand how individuals in varying cultures think about and discuss psychological issues (Wu, 2021). The cultural conceptualization interview schedule will assist physicians in determining cultural elements that influence patients’ perceptions of their illnesses and treatment alternatives. It contains inquiries regarding the patients’ cultural or ethnic heritage. Individuals can use the interview to characterize their suffering in their terms and then link it to how other parties that may not belong to their cultural background see their difficulties.
The motivations of those researching DSM-5 have frequently been questioned. They have already been accused of having a financial conflict of interest since they have drug industry affiliations and because numerous DSM-5 modifications would increase Pharma revenues by contributing to the already existing social overdose of recklessly administered psychiatric drugs (Shorter, 2021). However, the individuals working on DSM-5 and the claim are both unjust and false. They did make some highly terrible mistakes, but they did it with good intentions, not to aid the pharma industry.
The motivations of those embarking on DSM-5 have frequently been called into doubt. They have been claimed to have a financial conflict of interest since they have links to pharmaceutical companies and because many of the DSM-5 modifications would increase Pharma revenues by adding to the already existing social overdose of recklessly administered psychiatric drugs. Nevertheless, because of the folks working on DSM-5, the claim is both unjust and false. They have made terrible mistakes but did so with good intentions, not to aid the pharma industry.
Conclusion
Physicians’ perspectives on patients’ suffering should be incorporated into case compositions. Before reaching a diagnosis, a thorough examination of a person’s pathos experience must be performed. All DSM-5 modifications, except autism, relax diagnosis and risk to transform the existing diagnostic inflation into medical hyperinflation. Past DSM experience tells that if something in the diagnostic methodology can be abused and turned into a craze, it will be. Many individuals with natural grieving, attention deficits, and addictive behaviors will be incorrectly labeled as psychiatrically unwell and treated inappropriately shortly. As a result, persons with real mental issues that can be accurately identified and efficiently treated are already being taken advantage of. DSM-5 will exacerbate this by deflecting attention and precious resources aside from the genuinely sick and toward those with everyday issues that will suffer from being misidentified as mentally ill. Taking care of the mentally ill is a commendable and valuable occupation if there are boundaries that everyone follows.
References
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