Issues for DSM-V

Alarcón, Renato D.; Becker, Anne E.; Lewis‐Fernández, Roberto; Like, Robert C.; Desai, Parth Rakesh; Foulks, Edward F.; Gonzales, Junius; Hansen, Helena; Kopelowicz, Alex; Lu, Francis G.; Oquendo, María A.; Primm, Annelle B.

doi:10.1097/nmd.0b013e3181b0cbff

Cited by 75 publications

(16 citation statements)

References 11 publications

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“…17 Well-known examples include the overdiagnosis—in comparison to other groups—of psychotic disorders in black patients and of mood disorders in Hispanic patients. This overdiagnosis is thought to stem from many factors.…”

Section: Categorizing Mental Disordersmentioning

confidence: 99%

Independent Review Of Social And Population Variation In Mental Health Could Improve Diagnosis In DSM Revisions

et al. 2013

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At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions.

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Section: Categorizing Mental Disordersmentioning

confidence: 99%

Independent Review Of Social And Population Variation In Mental Health Could Improve Diagnosis In DSM Revisions

et al. 2013

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“…Whereas transethnic samples have been traditionally used to validate mainstream diagnostic criteria (Thakker and Ward, 1998), they provide an opportunity to examine differences in schizophrenia expression, as well as commonalities, both of which are important to a comprehensive nosological understanding (Kleinman, 1988; Alarcon, et al, 2009). …”

Section: Introduction/backgroundmentioning

confidence: 99%

DSM-IV “Criterion A” Schizophrenia Symptoms Across Ethnically Different Populations: Evidence for Differing Psychotic Symptom Content or Structural Organization?

McLean

Rangaswamy

John

et al. 2014

Cult Med Psychiatry

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There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia is contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n=776), India (n=504) and Sarawak, Malaysia (n=259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.

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“…Whether cultural psychiatry is applied as cultural case formulation, or as sharing care with indigenous healers, the problem remains that cultural psychiatry"s oversimplified framing of sociocultural processes is merely epiphenomenal and could result in essentialism, reductionism and ethnocentrism (Alarcón et al, 2009). Heath (2001, p. 483-484) calls for a broader view of culture:…”

Section: A Broader View Of Culturementioning

confidence: 99%

“…Prospective for a culturally responsive nosology Careful attention to the sociocultural dimensions of mental illness accordingly serves both a scientific and social justice agenda (Alarcón et al, 2009) Regarding oppression, social psychologists point to a variety of social and cultural factors that collectively disadvantage, devalue and disempower women (Barnett & Rivers, 2004;Fine, 2011). It should not be surprising that, according to the WHO (2013), gender is correlated with the prevalence of many mental disorders including depression and anxiety.…”

Section: Limitations Of Cultural Psychiatrymentioning

confidence: 99%

“…However, the following question was posed by some of the members of the SSPC: How is this different from ordinary, good diagnostic practice? Alarcón et al (2009) called for a sociocultural perspective throughout the manual. It was pointed out that most patients express distress in culturally embedded ways, which differ by region, age, gender, and local conditions and traditions (Messich et al, 2001).…”

Section: Limitations Of Cultural Psychiatrymentioning

confidence: 99%

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A critical engagement with the DSM-5 and psychiatric diagnosis

Kriegler

Bester

2014

Journal of Psychology in Africa

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Abstract:Classifications in psychiatry can result in the reification of hypothetical approaches, arbitrary categorization and social injustice. This article applies a social constructivist approach to critique the DSM-5 as a neurobiological model of psychiatric diagnosis which ignores psychosocial factors such as poverty, unemployment and trauma as causes of mental distress. It challenges the universality of psychiatric diagnosis and proposes that cultural psychiatry"s framing of "culture-bound syndromes," or "cultural case formulation" guidelines, is oversimplified. Use of the DSM in the South African context risks perpetuating injustice by labeling and stigmatizing people who have in the past been racially stigmatized by apartheid. In culturally diverse South Africa, psychiatric diagnosis should take into account alternative explanatory models that provide a more balanced view of the complex and dynamic relationship between biological and sociocultural forces in the manifestation of psychopathology.2

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Issues for DSM-V

Cited by 75 publications

References 11 publications

Independent Review Of Social And Population Variation In Mental Health Could Improve Diagnosis In DSM Revisions

Independent Review Of Social And Population Variation In Mental Health Could Improve Diagnosis In DSM Revisions

DSM-IV “Criterion A” Schizophrenia Symptoms Across Ethnically Different Populations: Evidence for Differing Psychotic Symptom Content or Structural Organization?

A critical engagement with the DSM-5 and psychiatric diagnosis

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