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Overdiagnosis, Mental Disorders and the DSM-5

Overdiagnosis, Mental Disorders and the DSM-5Is the DSM-5 — the book professionals and researchers use to diagnose mental disorders — leading us to a society that embraces “over-diagnosis”? Or was this trend of creating “fad” diagnoses started long before the DSM-5 revision process — perhaps even starting with the DSM-IV before it?

Allen Frances, who oversaw the DSM-IV revision process and has been an outspoken critic of the DSM-5, suggests melodramatically that “normality is an endangered species, ” due in part to “fad diagnoses” and an “epidemic” of over-diagnosing, ominously suggesting in his opening paragraph that the “DSM5 threatens to provoke several more [epidemics].”

First, when a person starts throwing around a term such as “over diagnosing, ” my first question is, “How would we know we’re ‘over diagnosing’ a condition, versus gaining a better understanding of a disorder and its prevalence within modern society?” How can we determine what is being accurately, better and more frequently diagnosed today, versus a disorder that is being “over diagnosed” — that is, being diagnosed when it shouldn’t be due to marketing, education or some other factor.

We could look at attention deficit disorder (also known as attention deficit hyperactivity disorder, or ADHD). The National Institutes of Health convened a panel in 1998 to examine the validity of attention deficit disorder and its treatments, out of concern for the rising amount of children being diagnosed with attention deficit disorder. However, they barely mention overdiagnosis as a concern for ADHD in their consensus statement. They do point out one of the primary problems is inconsistent diagnosing, which I agree represents a real, ongoing concern across the spectrum of mental disorders.

Research into this question has produced mixed results, showing that on one hand, we are indeed over-diagnosing even common, serious mental disorders like bipolar disorder, but we’re also missing a lot of people who have the disorder and have never been diagnosed — again, inconsistent diagnosing. Bipolar disorder should be fairly accurately diagnosed because its diagnostic criteria are clear and overlap with only a few other disorders. One such study that examined whether we are “over diagnosing” bipolar disorder was conducted on 700 subjects in Rhode Island (Zimmerman et al, 2008). They found that less than half the patients who self-reported as being diagnosed with bipolar disorder actually had it, but that over 30 percent of patients who claimed never to have been diagnosed with bipolar disorder actually did have the disorder.

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