Undisclosed Financial Conflicts of Interest in Dsm-5 (2024)

the psychologists, they never went to medical school, so despite forming an organization and many publications, have little to do with diagnostic standards for medical doctors.

for clarity: THERE ARE TWO APA, the one written about in the article is not the same as the one in this comment.

Phillip Zimbardo, and the link you linked to, are the "American Psychological Association".

These are two different associations.

Theresa Miskimen is the president of the American Psychiatric Association, not Zimbardo.

70% of people 60 years of age and older have high blood pressure[1], 50% of men regardless of age. Does this mean that our definition of high blood pressure needs work?

I'm not arguing that the DSM is perfect, but it's possible for something to be bad and also common. But I appreciate the "Keep taking your meds" sentiment as well, it has bigger problem overall, but it can still help people.

[1] https://www.cdc.gov/nchs/products/databriefs/db511.htm

you'd have to be crazy to not believe in demons

Yes

This has been known to economists for a long time

Medicine generally has had its progress (as a general good) held back by misaligned incentives for a long time

See "neglected tropical diseases"

As true in psychiatry as anything else

  - Acknowledgement by our professors that P-hacking (pruning datasets to get the desired results) was not just common, but rampant

  - One of our classes being thrown in limbo for several months after we found out that a bunch of foundational research underpinning it was entirely made up (See: Diederik Stapel).

  - Experiencing first-hand just how unreproducible most research in our faculty was (SPSS was the norm, R was the exception, Python was unused).

  - Learning that most psychology research is conducted on white psychology students in their early/mid-twenties in the EU and US. But the findings are broadly generalized across populations and cultures.

  - Learning that the DSM-IV classified homosexuality as a mental disorder. Though the DSM-V has since dropped this. 

Though I do generally hold psychologists in high regard (therapy is good), I'm not particularly impressed by psychology as a science. And in turn don't necessarily trust the DSM all that much.

I must admit, it feels a bit strange. The truth is that I learned my first steps in programming by working through large, formidable books. In fact, my very first programming book was Assembly Language for Intel-Based Computers by Kip Irvine. After that, I read even larger books, many of them multiple times.

I have always been fond of reading well-written books by knowledgeable professionals. After reading such works, you come away with real understanding, greater clarity, and often new creativity. Books are valuable, and I have always respected a good one.

Yet the DSM-5-TR is quite the opposite. The Preface clearly states that the work is intended for everyone:

“The information is of value to all professionals associated with various aspects of mental health care, including psychiatrists, other physicians, psychologists, social workers, nurses, counselors, forensic and legal specialists, occupational and rehabilitation therapists, and other health professionals.”

I happen to be a social worker, and I have read a lot of books. I know how to study. I carefully looked up any words I might have misunderstood and used the dictionary freely.

But despite all my efforts, I often failed to make sense of what I was reading. One would expect a theory followed by a conclusion, or an observation leading to a conclusion, or a theorem that is then proven. Unfortunately, that structure is missing here.

A typical DSM entry begins with a statement presented as fact, only to be followed by other statements that seem to contradict it.

Take, for example:

“The prevalence of disinhibited social engagement disorder is unknown. Nevertheless, the disorder appears to be rare, occurring in a minority of children, even those who have experienced severe early deprivation. In low-income community populations in the United Kingdom, the prevalence is up to 2%.”

This kind of contradictory phrasing is standard in the DSM.

Again, the DSM is publicly available, and anyone can read it here: https://www.ifeet.org/files/DSM-5-TR.pdf

I would have expected more precision from a scientific book.

When you do not have an objective metric to measure, prove, or hypothesize (as in physics, chemistry, etc), you're basically doing statistics on whatever arbitrary populations and bounds you choose with immeasurable confounders. That's why the replication crisis and p hacking are intrinsic properties of the social sciences

No. You need to read the thing.

The DSM only aims to be a tool to help standardize communication of often nebulous and otherwise ill-defined entities. It says so in the introductory pages.

People shouldn’t treat it like a biology textbook, it’s a self-described ontology at most.

By this criteria, you can then say many other non-psych conditions are not disorders.

What classifies as a disorder other than making life worse for someone?

There is no universal book given by a holy entity that we can read to classify something as normal or a disorder.

Why do we have arbitrary cutoffs for cholesterol, blood sugar, blood pressure, etc?

The DSM only matters if somebody is actively seeking treatment for something that they have a problem with in their own situation. So what’s in there is totally irrelevant for the public at large. It’s only if somebody shows up and says there’s something going on that they don’t like. It’s really just billing codes, man. The reality is far different anyway, and it just gets distilled down to these primitive codes.

I've seen that used before to dismiss the severity of conditions like autism and especially ADHD. It's often coming from a well-meaning place, and sometimes it's just a comforting story people tell themselves in order to not feel as deficient ("The problem isn't me, it's the system!").

It's also absolutely true that the demands society places on all of us are unnatural and often excessive, but the fact is that even absent all external expectations some people with mental illness will be unable to accomplish what they themselves want and should be able to accomplish.

Even the most utopian, accepting, accommodating society it wouldn't be enough to make up for some people's inability to function.

I feel the same about a lot of the "super power" talk when it comes to mental illness. There are advantages and disadvantages to just about anything, but on the whole conditions like ADHD or autism tend to do way more harm than good.

What's the alternative then? What would "empirically" determining what a "disorder" is look like?

>…by Americans

Most of the world outside of the US uses the ICD, not the DSM.

As a heuristic for identifying when something deserves attention?

A concussion? Obviously it’s not considered a psychiatric condition but concussions check a lot of the right boxes abstractly.

Our physiological system does have that uniformity across the population but our psychological system does not seem to. Isn't it then misguided to try characterizing small deviations when we don't even have a uniform "background" to subtract?

One of the biggest problems with psychiatry is that every diagnosis is a spectrum, and over time it's become more and more obvious that the boundaries for what is considered "neurotypical" are way too narrow.

Depression being a chemical imbalance was a complete lie to sell more medication, and how prolific this type of occurrence is within the industry is not hard to see.

At the very least, a plurality of phycological diagnoses are manifestations of physical behavior: diet, exercise, exposure to sunlight, etc

We're so overprescribed on medications to try to feel a certain way within far too narrow of a spectrum.

Why do you presume that there has to be an equivalent to a sprained ankle? Maybe the answer to your question is yes, only the catastrophic is worth addressing.

https://journals.plos.org/plosmedicine/article?id=10.1371/jo...