A new study published in Psychiatry Research has stated that psychiatric diagnoses are “scientifically meaningless”. Led by researchers from the University of Liverpool, the study analyzed five chapters from the latest edition of the Diagnostic and Statistical Manual (DSM) on schizophrenia, bipolar disorder, depressive disorders, anxiety disorders, and trauma-related disorders.
The Diagnostic and Statistical Manual offers mental health professionals diagnostic language to be used across services in order to provide a complete list of mental health conditions and the symptoms that characterize them.
The study, which is widely critical of the DSM’s oversight of the role of trauma in mental distress in particular, says the Manual implies that trauma only affects a “limited number of diagnoses, despite increasing evidence to the contrary”. It also states that individual experiences that may be contributing to a person’s distress may be “obscured” by the diagnostic criteria.
As trauma is only featured in one dedicated chapter, the Manual implies that trauma does not play a part in other mental health diagnoses. The researchers found that, problematically, personal experiences in this chapter on trauma-related disorders are seen as symptomatic of a disordered or inappropriate response to that trauma.
DSM-5 is ‘not fit for purpose’
There is mounting evidence demonstrating that trauma is involved in the development of a number of mental health conditions and symptoms. The study notes that labelling distress as abnormal may trigger more distress in the patient.
The DSM-5 does acknowledge that personal experiences do not always fit inside the boundaries of a specific mental health condition’s criteria, and the paper argues that this makes the Manual’s rules internally inconsistent.
To add to this heterogeneity that the paper criticizes, the research team’s analysis also found a great deal of overlap in symptoms between diagnoses.
This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder and relies heavily on subjective judgements about what is normal.”
Professor Peter Kindermann, University of Liverpool
When analyzing the perspective from which a person’s distress is assessed, the researchers found that the DSM favored the perspective of the clinician over the perspective of the patients themselves. When comparing the DSM—IV-TR and the DSM-5, they found that the DSM-5 criteria on social anxiety relied on the clinician’s perspective. The researchers note:
“Represented within this shift towards the perspective of the observer is an assumption about insight and the capacity to self-report […] However, this assumption is not explicitly states in the diagnoses, and therefore reinforces the fallacious assumption that all people experiencing mental health problems tend to ‘lack insight’”.
Lead researcher Dr. Kate Allsopp from the University of Liverpool said:
“Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”
The study concludes by suggesting, “A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may […] be a more effective way of understanding distress than maintaining a commitment to a disingenuous categorical system.”
In further criticism of diagnostic labeling, Professor John Read, from the University of East London, said:
Perhaps it is time we stop pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”
Allsop, K., et al. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research. https://doi.org/10.1016/j.psychres.2019.07.005.