What’s in a name?
A brief cognitive-behavioural view on the publication of the new DSM-5
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychological Association (APA) was released on May 2013. Much controversy has been surrounding it, as there are some important changes in classifications of disorders. Articles in newspapers and magazines in different parts of the world have commented on the increase in the number of mental disorders and how anyone could be fitted in a category and thus receive a psychiatric diagnosis.
In fact, there has been an increase in the number of disorders listed. The first DSM, published in 1952, contained only brief descriptions of 106 disorders. This was increased to 182 disorders in DSM-II, 265 in DSM-II, 292 in DSM-III-R and 297 in DSM-IV and DSM-TR. What does this mean? Has the number of disorders been really increasing? This is a complex issue for which I do not have a complete answer and I would not dare to explore in a few lines. But we do need to consider that the field of mental health has evolved a lot since 1952 and continues to progress. Evidence from scientific research has helped to refine diagnoses and changes in our world have also challenged mental health professionals with new issues that still need to be further investigated, such as compulsive internet use.
How does this affect psychology and psychotherapy? As an undergraduate student, I learned that the human being is a biopsychosocial organism. That is, we suffer influences from biological (i.e. genes), psychological and social factors and/or a combination of any of them. A psychotherapist will strive to understand how all these factors have combined and impacted a person’s life and current issues. Grouping symptoms into a category and finding a diagnosis can be very helpful. It provides guidance on treatment options available and what could be the best path to improve the quality of life of that particular individual. I have never opposed psychiatry or psychiatric medication. On the contrary, I do believe it is necessary and welcomed in some cases.
Nevertheless, for psychologists, especially cognitive behavioural psychologists, this description or the name of any mental disorder is only topographic. It provides a description of what a behaviour (or a set of behaviours and cognitions) looks like. In psychotherapy, we are more interested in understanding the function of any behaviour and cognition. In other words, why is a specific behaviour and/or thought pattern present, what has influenced the development of such behaviours and cognition, what is maintaining them, what consequences they bring to the individual’s life.
I believe the DSM-5 should be treated as what it is, a manual. Any treatment needs to be adapted to the needs, wishes, strengths and difficulties of each unique person. No manual, guidelines or computer programs should ever preclude good clinical judgment.