Psychiatrists Criticize New US Diagnostic Manual

German psychiatrists criticize the new edition of the US Diagnosis Manual for Mental Diseases

04/18/2013

Renowned neurologists and psychiatrists criticize the new Manual of Mental Diseases of the American Psychiatric Association (APA). In this context, they speak of one „almost inflationary use of diagnoses of mental disorders“. According to the handbook, grief over the loss of a loved one that lasts more than two weeks is already a mental illness worth treating, because the feeling of grief then leads to depression.

Find one „Inflation of diagnoses“ instead of? Psychiatrists and psychotherapists in Germany criticize the new US manual. It states, among other things, that one „prolonged grief“ into a disease. If sadness, loss of appetite, difficulty concentrating and apathy last more than 14 days after bereavement, the new diagnostic system speaks of a depressive episode that should be treated.

In May of this year, the new edition of the disease catalog of the American Psychiatric Association (APA) will be published. It is now the fifth version of the edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5 for short. According to a pre-publication, physicians and psychotherapists are advised to consider depressive mood after the death of a loved one after 14 days as a possible depression and treat. So far, the grief over the loss of a close person was considered an emotional exceptional case.

Renowned psychiatrists critical reissue of the manual
Respected psychiatrists such as Allen Frances of the American Duke University warn for some time before an inflation of diagnoses in the field of mental illness. Following the publication of the preliminary information, the German Psychiatric Association and Psychotherapy, Psychosomatics and Neurology (DGPPN) has now also intervened in the debate. According to the psychiatrist that is „Although the US manual is no direct guideline for the work of psychiatrists in Germany“, but it could have indirect influence for the reissue of the classification system of diseases of the World Health Organization, so the fear. The classification is also known in Germany as ICD-10 and is instrumental in diagnostics.

The DGPPN President Wolfgang Maier from the University of Bonn and his colleagues Peter Falkai from Munich and Andreas Heinz from the Berlin Charité criticize the subject of mourning that the DSM-5 „the usually natural loss of mourning sensation and the mostly preserved ability to self-regulate“ disregard. That could then cause a number of patients to wrongly diagnose „Mental disorder“ receive. In turn, psychiatrists believe that this would mean that patients with severe mental disorders would no longer receive adequate help.

Another point of criticism is the growing memory weakness in old age, which in the DSM-5 in undramatic processes also receive a disease value. Here is the new diagnosis „Minor neurocognitive disorder“ (low mental dysfunction). There is no here „effective therapy“ and that's why, according to the critics, it's not right, „Forms of forgetfulness“ to be regarded as a disease.

In the crosshair of criticism is also the so-called „Substance use disorder“. This diagnosis is one „Group diagnostics“ for addictions, in which the harmful use of stimulants and a real dependencies are summarized. With this new form of diagnosis, the physicians fear that the borderline between the consumption of alcohol could lead to social problems that mix with genuine addiction.

However, the critics of the DGPPN emphasize that some diagnoses listed in the DSM-5 „have no disease value and belong to normal life“. The experts were also able to gain something positive from the manual. So there are complaints that are no longer listed in the new edition as a separate disease. This includes the so-called „Burnout syndrome“, that in Germany media attention is strong. The „Exhausted syndrome“ be rather a depression. In the meritocracy, however, would prefer „Burnout“ used, because this also suggests high performance. (Sb)

Picture: Gerd Altmann