Psychologist attitudes toward DSM-5 and its alternatives.

Abstract

A survey of psychologists’ attitudes toward the Diagnostic and Statistical Manual of Mental Disorders–5 (DSM-5), and its alternatives was conducted. Almost 90% of psychologists reported regularly consulting DSM-5, despite dissatisfaction with it. However, opinions varied by theoretical orientation. Cognitive-behavioral psychologists held positive attitudes about DSM, whereas psychodynamic and humanistic/constructivist/systems psychologists were negatively inclined toward it. Integrative/eclectic psychologists were in between. Diagnostic codes and identifying pathology were seen as DSM-5’s biggest advantages, and the medicalization of psychosocial problems and obscuring individual differences as its biggest disadvantages. Psychologists supported developing alternatives to DSM-5, but when asked about six alternatives—International Classification of Diseases (ICD), Research Domain Criteria (RDoC), Psychodynamic Diagnostic Manual–2 (PDM), Operationalized Psychodynamic Diagnosis (OPD), Hierarchical Taxonomy of Psychopathology (HiTOP), and Power Threat Meaning Framework (PTMF)—they were generally unfamiliar with them except for ICD. Although not wishing to abandon the medical model, psychologists (except for cognitive-behaviorists) said DSM-5 relies too much on medical semantics and questioned whether mental disorders should be considered a subset of medical disorders. Overall, psychologists use DSM for practical reasons (diagnostic categories and codes) more than scientific ones (validity and reliability). This finding affirms something remarkable: Despite ongoing attention to revising and improving DSM over the past four decades, psychologists remain lukewarm toward it and strongly interested in alternatives. However, until alternatives are better known and provide the necessary practical advantages, psychologists will likely continue to use DSM despite their mixed feelings about it.

Do we need a novel framework for classifying psychopathology? A discussion paper

“…For example, Balling et al (2022) found that clinicians rated HiTOP as having better clinical utility than the DSM when applying both systems to a clinical vignette. Raskin et al (2022) also found support from psychologists for alternatives to the DSM-5 in principle, but in practice they were unfamiliar with HiTOP.…”

Hierarchische Taxonomie der Psychopathologie (HiTOP): Ein neues Modell zur Beschreibung psychischer Probleme

“…Insgesamt führen die hier genannten Kritikpunkte dazu, dass Forschungsergebnisse zu einzelnen Störungen schwer interpretierbar sind und Diagnosen für die individuelle Fallformulierung und Therapieplanung oft als nicht sonderlich nützlich wahrgenommen werden (Balling et al, 2023;Bornstein & Natoli, 2019;First et al, 2018;Raskin et al, 2022).…”

The biological paradigm of psychosis in crisis: A Kuhnian analysis

“…As competing theories regarding the origins and potential treatments of psychosis have become myriad (Bentall, 2004; Cooke, 2017), examples can be seen in clinical mental health practice of what Kuhn (1962, p. 69) describes as the ‘breakdown of normal technical puzzle solving activity’. The instruments that historically had been used to support the ‘normal science’ of working within the biological paradigm, such as the diagnostic and statistical manual (American Psychiatric Association, 2013) to classify mental illness, are perceived as having less value within contemporary healthcare (Raskin et al, 2022). Moreover, the tools that had previously been considered the foundation of practice, such as antipsychotic medications are treated with much greater ambivalence, and for some are no longer the primary focus of therapeutic work (Bressington & White, 2015; Morant et al, 2018; R. M. Murray et al, 2016; Odeyemi et al, 2018).…”