DSM-V Additions: Eccentric Behaviors or True Disorders

January 23rd, 2013 | Add a Comment

Controversy always seems to be abundant whenever a new edition of The Diagnostic and Statistical Manual of Mental Disorders is published. The most recent edition, the DSM-IV, published in 1994, saw the deletion of four personality disorders from the previous edition, which had been published fourteen years earlier. Among those personality disorders not included in the fourth edition were depressive personality disorder, paranoid personality disorder, and passive-aggressive personality disorder.

The controversy surrounding the removal of mental disorders from one edition of the DSM to the next often pales in comparison to the ruckus that ensues with the inclusion of new disorders to the manual often referred to as the “bible” of mental health. The upcoming DSM-5, set to be published in May 2013, is already causing a stir some four months before its release. Hypersexual behavior, gender identity disorder, disruptive mood dysregulation disorder, and binge eating disorder are among the newly-recognized mental disorders making their debuts in DSM-5, and each has set off a firestorm of ridicule, debate, curiosity, and confusion among both mental health professionals and the general public.

How helpful are these additions to the cause of improved mental health, and how much harm might be done by pathologizing behavior that may have once been viewed as merely eccentric or unconventional? Given that stigma often accompanies the diagnosis of a mental disorder, an argument could be made that the “cure” can be worse than the disease. Certainly, what is considered a disease (i.e., what is abnormal) and what’s not (i.e., what is normal) is a rightfully contentious issue, especially when it comes to a person’s mental health.

As Peter Kinderman, Professor of Clinical Psychology at the University of Liverpool, has pointed out, the inclusion of a whole new class of mental disorders called “behavioral addictions” has turned excessive interest in nearly anything that provides instant gratification, including sex and internet surfing, into mental health abnormalities requiring treatment, which often includes either therapy, pharmaceuticals, or a combination of the two. While those diagnosed might devote a seemingly disproportionate amount of time to these interests—to the point where it interferes to some degree with other, “healthier” activities and interests—does that fact alone constitute mental illness?

Writes Kinderman, “Standard psychiatric diagnoses are notoriously invalid (and) do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.”

Unfortunately, even when there is the need for professional help, the reasons for a diagnosis might serve as more than just a means to identify a person’s malady.

“In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects,” says Kinderman.

Kinderman adds that the roles played by abuse, poverty, social deprivation, and other biological and environmental factors need to be assessed when determining why people are the way they are. Not all bad things result in mental illness, nor are all less-than-desirable behaviors the result of mental illness. By defining all forms of abhorrent and less-than-ideal behavior as defective or pathological, might we end up creating more of it?

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