Diagnostic and statistical manual‑5: Position paper of the Indian psychiatric society

Abstract

The development of the Diagnostic and Statistical Manual-5 (DSM-5) has been an exhaustive and elaborate exercise involving the review of DSM-IV categories, identifying new evidence and ideas, field testing, and revising issues in order that it is based on the best available evidence. This report of the Task Force of the Indian Psychiatric Society examines the current draft of the DSM-5 and discusses the implications from an Indian perspective. It highlights the issues related to the use of universal categories applied across diverse cultures. It reiterates the evidence for mental disorders commonly seen in India. It emphasizes the need for caution when clinical categories useful to specialists are employed in the contexts of primary care and in community settings. While the DSM-5 is essentially for the membership of the American Psychiatric Association, its impact will be felt far beyond the boundaries of psychiatry and that of the United States of America. However, its atheoretical approach, despite its pretensions, pushes a purely biomedical agenda to the exclusion of other approaches to mental health and illness. Nevertheless, the DSM-5 should serve a gate-keeping function, which intends to set minimum standards. It is work in progress and will continue to evolve with the generation of new evidence. For the DSM-5 to be relevant and useful across the cultures and countries, it needs to be broad-based and consider social and cultural contexts, issues, and phenomena. The convergence and compatibility with International Classification of Diseases-11 is a worthy goal. While the phenomenal effort of the DSM-5 revision is commendable, psychiatry should continue to strive for a more holistic understanding of mental health, illness, and disease.

Psychosocial adversity and mental illness: Differentiating distress, contextualizing diagnosis

“…[35] Psychiatric theory is forced to fit the evidence generated, which is in turn based on current biomedical models. Its diagnostic systems and models do not explain many aspects of mental-health and illness.…”

“…distracts us from the task of trying to understand the complex interaction and interdependence of issues related to mental health and illness. [35]…”

Depression: Disease, distress and double bind

“…call for renewed efforts at individualising assessments and treatment to optimise care (Jacob et al, 2012). Consequently, the disadvantages of categorisation (e.g.…”

A Review of Dissociative Identity Disorder Research

“…The DSM, which is heavily based in Western culture, just touches on the diversity of syndromes across cultures, however. For example, the Indian Psychiatric Association recently criticized the DSM revision process because the disorders do not represent the manifestations of dissociation in their culture and result in an overreliance of the NOS category (Jacob et al, 2013). Overall, considering DID to be somehow above or immune to cultural influence is too simplistic, and it is misleading to portray an argument for cultural influence as tantamount to argument for a single, cultural cause.…”