DSM-5: A Hopeful Future?
I currently work as an assistant psychologist within a Child and Adolescent Mental Health Service, on a diagnostic pathway. My work primarily involves assessing children for developmental disorders. In terms of academia, I studied psychology at BSc level and clinical psychology at MSc level.
It is clear that people experiencing mental distress need to be provided with appropriate care and support, whether it involves evidence-based pharmacotherapies or psychotherapies. It also remains crucial that people, as well as clinicians, are able to both understand and manage distressing psychiatric symptoms and find alternatives to cope.
The most effective psychological support derives from a clinical diagnosis, whereby the DSM-5 manual (American Psychiatric Association, APA, 2013) is commonly used by clinicians and researchers to diagnose and classify mental disorders. Over the years, the DSM-5 has changed dramatically.
In 1900’s, Autism spectrum disorders (ASD) were even considered as childhood schizophrenia and homosexuality was shockingly listed as a sociopathic personality disorder. Thankfully, this view is not the case in the 21st century. The DSM-5 has evolved significantly and remains an ever-changing manual whereby disorders are added and removed frequently.
Having a clinical diagnosis of a mental health disorder usually leads to effective care and support. In addition, many individuals feel a sense of security when they have a diagnosis and are better able to understand why they may be feeling or behaving in a certain way.
Some people have even stated that not having a diagnosis and waiting for a clinician to unpick which diagnosis they fall under is the most anxiety-provoking part of their mental health care. In spite of this sentiment, having a diagnostic label can additionally link to stigmatization, which can then lead to significant consequences such as family rejection and discrimination (Shrivastava, Johnston & Bureau, 2012).
This long-standing debate has captured my interest greatly as it has many others. I am keen to wonder whether we should treat the individual psychological symptoms one is experiencing, rather than classify a unique being into a classification group where they may or may not meet the full criteria of the ‘required’ symptoms.
It needs to be remembered that everyone is different and no two people experience depression, schizophrenia or anxiety disorders in the same, definite way.
I therefore find it difficult to understand how we can follow a manual that is so exact with which symptoms need to be met for a diagnosis in order for an individual to receive the appropriate help, when people’s experiences are largely subjective and unique.
Although this idea has been previously discussed by researchers, while working as an assistant psychologist in a Child and Adolescents Mental Health Service, I have come to realize how people experience such diverse symptoms.
In addition, I fail to understand why, as a society, we feel it is acceptable to classify people in a ‘tick-box’ manner. To me, there is no ‘one size fits all.’
In spite of this argument, it is clear to see how having a diagnostic manual has been beneficial for both professionals and patients. Currently, it is the best option we have to classify and treat disorders. I hope that the future of clinical psychology will bring a more holistic take on diagnosis and that a person’s individual symptoms are considered and treated, rather than the classic ‘tick-box’ diagnostic manual method.
I believe that we should aim to treat the individual we are presented with physically, not the disorder that they are experiencing internally.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA, 2013.
Shrivastava, A., Johnston, M.D., & Bureau, Y. (2012). Stigma of Mental Illness-1: Clinical reflections. Mens Sana Monographs, 10(1), 70-84. doi:10.4103/0973-1229.90181
Frances A. J. (2012, Dec, 02). DSM 5 Is Guide Not Bible – Ignore its Ten Worst Changes. Retrived from https://www.psychologytoday.com/blog/dsm5-in-distress/201212/dsm-5-is-guide-not-bible-ignore-its-ten-worst-changes
NHS Choices (2013, August 15). News analysis: Controversial mental health guide DSM-5. Retrieved from http://www.nhs.uk/news/2013/08August/Pages/controversy-mental-health-diagnosis-and-treatment-dsm5.aspx
Competing interests: No competing interests
Kruger, E. (2017). DSM-5: A Hopeful Future?. Psych Central. Retrieved on November 22, 2017, from https://pro.psychcentral.com/dsm-5-a-hopeful-future/0018983.html