It is fair to say that there never was such a fuss and hullabaloo surrounding a psychiatric manual as there has been about the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, put out by the (psychiatry loves initials) APA (American Psychiatric Association) in May 2013, a year and a bit behind schedule.
For sheer pettiness, consider the critique of the new–and, some said, childish– edition numbers . All previous DSMs used Roman numerals. The original format of the DSM-I in 1952, was followed through the DSM-IV in 1994.. Even when that desperately needed changes, they clung to the format and, voila: the somewhat awkward DSM-IV-TR (Text Revision). Traditional folks were less than pleased with that big fat “5” in place of the more scholarly and traditional “V” that many felt should have graced this latest DSM‘s title.
Things went downhill from there.
Before we even get to the meat and bones, there was the issue of the, well, the elegance of the writing. Psychiatrist Allen Frances is best known for having chaired the DSM-IV Task Force. Apparently finishing that job left a lot of time on his hands, towards which he put great chunks criticizing the DSM-5. I can’t really think of one thing he liked, but apparently the writing was just inexcusable. Says the good doctor, “The DSM-5 writing is remarkably amateurish — even more imprecise than I expected and my predictions for it were pessimistic.” He goes on to give 18 examples–but I’ll spare you.
But what concerned most of the chronic complainers–and even some of those who didn’t seem to get their jollies out of DSM-5 bashing–was that the updated manual added 15 new mental illnesses. This is indeed cause for some anxiety, since there will need to be people, I assume, to meet the criteria of these illnesses, and–and I may speak for most people here–we’re not really hanging around thinking, “Gosh, I’d like to be labeled with a mental illness today.”
I managed to work myself up during the writing of the manual. Please, I was a pale imitation of Dr. Frances, but I did write some blogs on the new disorders, which I link here, in case you also want to feel righteous and indignant. The two substantive changes that distressed most people concerned 1) the time distinction between normal bereavement and a diagnosis of depression (“Pathologizing Grief–Just For Starters: The DSM-5 and My Tripartite Expression of Displeasure, Getting Started“), and 2) a brand-spanking new diagnosis for children, entitled Disruptive Mood Dysregulation Disorder, which the new manual prefers to diagnosing children with bipolar disorder. That sounds pretty positive to me, but our friend Frances had this to say (just for starters): “Everyone must have known that DMDD is a made up and unstudied diagnosis with no real scientific support.” (Feel free to link to “You Say Potato, I Say. . .Disruptive Mood Dysregulation Disorder” for more exciting back and for–and even a real life picture of the doctor himself.)
Perhaps the most mocked, the most maligned, had to do with (and I am getting to the point; did you honestly think I’d never get there?) the inclusion of–you are ready for this by this point, aren’t you?–caffeine withdrawal in the Fifth Diagnostic Manual of Mental Disorders.
I have my moments where I agree with Dr. Frances–and some more where I think he’s a crank– but he says that when they were putting together the DSM-IV, the Task Force thought to itself, “Will adding this diagnosis [caffeine dependence and withdrawal] trivialize the concept of mental disorder [italics mine]? It was for this reason alone that we excluded caffeine dependence in DSM-IV.”
So let me be fully clear–if you let your eyes travel down the infographic, past how much caffeine is in coffee and past comparisons to other beverages, you’ll come to symptoms of caffeine withdrawal. They made a valiant effort to list the symptoms–and their little graphic is so cute I overlook the fact that they seem to be operating on somewhat less than full DSM-5 speed. The manual includes caffeine withdrawal in its own section entitled (so it won’t be lonely) “Caffeine-Related Disorders” and includes the following 5 symptoms (perhaps the infographicers didn’t want to deal with vomiting):
marked fatigue or drowsiness;
dysphoric or depressed mood, or irritability;
difficulty concentrating; or
nausea, vomiting, or muscle pain/stiffness.
You meet 3 or more of those criteria (and, let’s be honest here, if you skip your cup of coffee, aren’t the first 3 a forgone conclusion??)–welcome, to. . .is it the world of mental illness? Can you get insurance coverage for therapy for this “issue”? If it goes on for days–could you be eligible for temporary disability? Would this prevent you from purchasing a gun, if, in, say, 2 decades, Congress ever decides to pass background checks?
You know what? I really have an awful lot to think about. Why don’t you check out this infographic?