Diagnostic and Statistical Manual of Mental Disorders: DSM-V on its way… but how much can we trust it?

The American Psychiatric Association (APA) is a very powerful body that has, since 1952, produced various versions of the Diagnostic and Statistical Manual of Mental Disorders – and the fifth edition is on its way.

The DSM is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States of America and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. There have been five revisions since it was first published in 1952, gradually including more mental disorders, although some have been removed and are no longer considered to be mental disorders, most notably homosexuality.

In 1952, the manual was 130 pages long and listed 106 mental disorders… by 1994, DSM-IV was listing 297 disorders in 886 pages.

It has been alleged that the way the categories of the DSM are structured, as well as the substantial expansion of the number of categories, are representative of an increasing medicalisation of human nature, which may be attributed to disease mongering by pharmaceutical companies and psychiatrists, whose influence has dramatically grown in recent decades. Of the authors who selected and defined the DSM-IV psychiatric disorders, roughly half had had financial relationships with the pharmaceutical industry at one time, raising the prospect of a direct conflict of interest.

In the past, I have written about the DSM and I’m not a fan of what I consider to be a deeply flawed publication, whose main reason to exist seems to be to enable drug companies to sell more drugs for newly diagnosed ‘disorders’. It’s just another part of the modern marketing mix.

But I had better be careful what I write, as the APA jealously guards its property – see here.

And the APA itself isn’t really whiter than white – In 2008 it became a focus of congressional investigations regarding the way that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions.

The drug industry accounted in 2006 for about 30 percent of the association’s $62.5 million in financing, half through drug advertisements in its journals and meeting exhibits, and the other half sponsoring fellowships, conferences and industry symposiums at its annual meeting.

A recent APA president, Alan Schatzberg, came under fire after it came to light that he was principal investigator on a federal study into a drug being developed by Corcept Therapeutics, a company Schatzberg had himself set up and in which he had several millions of dollars’ worth of stock.

It’s all just a little bit too cosy, I reckon.



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