BPS concerns about overmedicalisation

The British Psychological has expressed strong reservations about the approach taken by the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which will be published in May 2013. The manual is widely used in Britain to diagnose and classify people suffering from mental health problems.

The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences. These responses which undoubtedly have distressing consequences that demand helping responses, but do not reflect illnesses so much as normal individual variation.

Professor Peter Kinderman from the University of Liverpool, the lead author of the Society's response to the draft manual released for consultation said:

“The putative diagnoses presented in DSM-V are clearly based largely on social norms, with ‘symptoms’ that all rely on subjective judgements, with few confirmatory physical signs or evidence of biological causation.

“We have particular concerns over the draft’s consideration of the inclusion of a range of highly contentious ‘disorders’. These include Attenuated Psychosis Syndrome, which could be seen as an opportunity to stigmatise eccentric people, and to lower the threshold for achieving a diagnosis of psychosis, Gender Dysphoria (especially in children and adolescents) and a range of conduct disorders such as Oppositional Defiant Disorder – diagnosed when a child is ‘headstrong’ or ‘wilful’.”

The Society is concerned that such diagnostic systems fall short of the criteria for legitimate medical diagnoses. It recommends a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that mental ill-health is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are important causal factors.

The Society believes that alternatives to diagnostic frameworks such as case formulations (whether from a single theoretical perspective or more integrative) exist, should be preferred and should be developed with as much investment of resource and effort as has been expended on revising DSM-IV.

The full text of the response is available on the Society's website.