The social side effects of the new DSM-5


The controversy around the new Diagnostic and Statistical Manual (DSM, fifth edition or DSM-5) is thick.

The new "psychologist's bible" adds many new mental illnesses and changes to others that will surely cause problems for insurers, the insured and the courts.

More than half of the population meets diagnostic criteria

The new manual will result in thousands of new diagnoses, each of which will have social effects on the patient that are hard to quantify. According to Ronald Kessler and Philip Wang, both professors at Harvard, about half of the population will meet the criteria for a diagnosis from the DSM in their lifetimes. That report, published in 2008, was using the older manual. Most agree that the new, fifth edition will result in even more.

Many (perhaps most) who suffer from a mental illness never see a mental health professional and are thus never officially diagnosed. So the near-50-percent number that the Harvard professors found was probably low. That might seem like a lot of mental illness, but nearly everyone will have a physical ailment in his or her lifetime, so assuming most will have a mental one too is not difficult to believe – especially given the wide variety and relatively loose, subjective diagnosis options in the DSM.

Changes made to the DSM perpetuate stigma

The most common reason for avoiding mental health issues are the stigmas attached to them. Many people view mental illness as a weakness or unpredictable problem that cannot be tolerated. Even more people are just unsure how to deal with someone who's mentally ill and are afraid of doing something wrong, inappropriate or that will be misinterpreted. This stigma turns on the person who may have the illness and who avoids treatment in order to avoid having the stigma itself.

Expanding the number of mental illnesses by adding to the manual and/or making it easier to diagnose someone is only adding to the problem. The other stigma, the one where many believe that the mentally ill are "faking it," is also strong and creating easy "everyone-has-problems" perceptions that only add to that.

The new DSM-5 will have social side effects that cannot be avoided. And they will affect nearly all of us.

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