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Are DSM and logic not on good terms?

  • Peter Dome (a1), Zoltan Demeter (a2), Xenia Gonda (a3) and Zoltan Rihmer (a4)

Summary

We would like to draw attention to the fact that the recently published DSM-5 (and also its predecessor, DSM-IV) contains annoying errors that are mainly logical in nature. These mistakes are undoubtedly a result of inadvertence, rather than either conceptual (professional) disagreements between authors/editors or shortage of scientific data for appropriate circumscription of diagnostic categories. The good news is that since these errors are mainly logical ones, they can be recognised and repaired.

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Copyright

Corresponding author

Peter Dome, Semmelweis University, Kútvölgyi út 4, Budapest H-1125, Hungary. Email: dome_peter@yahoo.co.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA, 2013.
2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
3 Lieberman, JA. Psychiatry on the scientific spectrum. New York Times 2013; 29 May (http://www.nytimes.com/2013/05/30/opinion/psychiatry-on-the-scientific-spectrum.html?_r=0).
4 Reese, H. The real problems with psychiatry. Atlantic 2013; 2 May (http://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/).
5 Frances, A. ICD, DSM and the Tower of Babel. Aust NZ J Psychiatry 2014; 48: 371–3.
6 Frances, AJ, Nardo, JM. ICD-11 should not repeat the mistakes made by DSM-5. Br J Psychiatry 2013; 203: 12.
7 Reardon, S. NIH rethinks psychiatry trials. Nature 2014; 507: 288.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Are DSM and logic not on good terms?

  • Peter Dome (a1), Zoltan Demeter (a2), Xenia Gonda (a3) and Zoltan Rihmer (a4)
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eLetters

Has the DSM Reached its Sell by Date ?

Leigh A Neal, Consultant Psychiatrist, 10 Harley Street, London
06 August 2015



In the editorial “Are DSM and Logic not on good terms ?” Dome et al, (2015) rightly accuse the DSM committee of “inattentiveness” and of “non-conceptual errors” in producing illogical diagnostic criteria specifically in the domains of serious mental illness. However, it does not take much effort to find confusion elsewhere in the DSM. The diagnosis of DSM-5 Somatic Symptom disorder (p311) is made if the individual has a distressing somatic symptom defined in the text as “most commonly pain” or “fatigue” which persists for 6 months and the person has a persistent “high levels of anxiety” about the symptom. The diagnosis of a DSM-5 Adjustment disorder (p266) is made if the individual develops clinically significant anxiety symptoms within 3 months of the onset of the stressor and the stressor as defined in the text may be a “painful illness with increasing disability”. However, an Adjustment disorder diagnosis cannot be made if this stress related disturbance meets the criteria for another mental disorder, such as a Somatic Symptom disorder. These criteria effectively force the diagnosis of an Adjustment disorder to change to a Somatic Symptom disorder once the somatic symptom stressor has been present for 6 months or more. However, this may not be the intent of the DSM according to the Adjustment disorder text, which states: “if the stressor or its consequences persist the Adjustment disorder may also continue to be present and become the persistent form”. There is no assistance with this conundrum under the differential diagnosis sections for both diagnoses. In addition to the problems identified with diagnosing serious mental illness with the DSM by Dome et al (2015) Somatic Symptom disorder has the appearance of a new diagnostic algorithm, which has not been fully thought through by the architects of DSM-5. The DSM has been published for the last 60 years, but riven with over-complexity and errors, perhaps it has now reached its sell by date.

Dome P., Demeter Z., Gonda X., Rihmer Z. Editorial: Are DSM and logic not on good terms. British J Psychiatry. 2015. 207. 91-92.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Edn) (DSM-5) APA, 2013.

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