Controversial Update to Psychiatric 'Bible'


The Diagnostic and Statistical Manual of Mental Disorders, known unofficially as the bible of American psychiatry, unveiled a much-anticipated fifth edition this weekend. The DSM was last updated nearly 20 years ago.

"The new manual ... represents the strongest system currently available for classifying disorders," DSM-5 Task Force chair Dr. David Kupfter said in a statement. "It reflects the progress that we have made in several important areas."

But Dr. Thomas Insel, director of the National Institute of Mental Health wasted no time in calling the new edition "weak" in its "lack of validity."

“Unlike our definitions of ischemic heart disease, lymphoma or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure," said Insel. "In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

The new DSM edits include the additions of binge eating disorder and premenstrual dysphoric disorder; the separation of hoarding into its own category separate from OCD; additions to Post Traumatic Stress Disorder’s list of behavioral symptoms; and the altering of the definition of ADHD to allow for diagnosis in adults, among other shifts.

In defense of the book’s edits and the diagnostic methods used to arrive at the information, American Psychiatric Association President Dr. Jeffrey Lieberman said: “It can’t create the knowledge, it reflects the current state of our knowledge. Clinicians and patients need the DSM-5 now."