Name: Can We Trust The DSM-5?
Uploaded: 2025-06-18T10:19:28.000Z
Duration: 10 min 54 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

You are not awfully anxious or completely calm, but are typically somewhere in between, and also always something else, say, tired.

All mental states exist on a spectrum, and the same is true for Autism Spectrum Disorder, Borderline Personality Disorder, Major Depressive Disorder, or any other mental state.

There are millions of variations within each, and most are overlapping with others.

This overlap is known as comorbidity, and it gets more complicated.

Unlike a broken leg, your mental health, or the lack thereof, has highly complex origins.

Schizophrenia, for example, tends to run in families and might be mostly genetic.

Anxiety can be the result of genetic traits, prenatal stress, childhood trauma, and random events.

Most mental disorders also lack clear biomarkers.

Biological factors are either too complex to identify, or too expensive to analyze.

This ambiguity is the very reason doctors came together to describe and classify all the atypical behaviors they saw.

The creation of common labels was necessary for both psychiatrists and patients to understand what was going on and talk to each other.

And so, whenever psychiatrists in the United States and Australia see someone, they follow the guidelines of the Diagnostic and Statistical Manual to assess and categorize their patients.

The DSM is sold by the American Psychiatric Association.

Doctors in the rest of the world also use the International Classification of Diseases to diagnose mental problems.

The ICD is published by the World Health Organization.

Both publications greatly influence what clinicians and government officials consider normal or abnormal behavior.

For example, according to a previous version of the DSM, homosexuality was known as a sociopathic personality disturbance.

After an update of the book in 1974, doctors could no longer officially consider it a mental disorder, even if they wanted to.

Politicians all around the world follow the book's guidelines to understand who is mentally sick, who is not, and whether public health insurance that we pay with our taxes should cover treatments that include medication or pay for a therapy that doesn't involve drugs.

And in the hands of doctors, the contents of these two manuals can determine whether a girl is considered healthy, even if she is not, or is prescribed mood stabilizers, even if she might not need them, which may happen considering that 1 in 10 teenage girls in the United States today take antidepressants.

Now, the lack of clear biological evidence is the reason why neither the DSM nor the ICD have introduced biological or genetic factors into their classifications.

Psychiatrists hence mostly rely on what they see with their own eyes, subjective self-reports, multiple-choice tests, and what family members tell them.

The combination of comorbidities and the lack of clear evidence is a problem.

It is highly unlikely that even the best doctors could reliably identify one specific disorder among hundreds of options that tend to overlap, especially if they try to treat children who themselves have no idea what's going on.

Consider autistic people who often start speaking at a later age and like routines because they need predictability, and kids with ADHD who have no problem speaking and crave excitement and novelty.

A boy born with both could be bored by routines but overwhelmed by novelty, and since he lacks the language to explain his feelings, he might be misdiagnosed with generalized anxiety disorder.

On top of this already highly complex situation are four other challenges.

Normal mental states may get pathologized.

The list of disorders gets longer and longer, and the research on many conditions might have started off biased.

The fifth and latest edition of the DSM was published in 2013.

It contains 297 disorders, ten times the number of diagnoses that the project started with in 1917.

Here are five examples of what changed and what didn't.

The criteria for autism, eating disorders, and depression were broadened.

The new definitions together with an increase in public awareness and lifestyle changes could contribute to what's known as diagnostic inflation.

Data from health insurance claims of 41 million Americans shows that the diagnosis of major depression in 12 to 17 year olds increased from 1.6% in 2013 to 2.6% in 2016, which means it became 63% more common.

The update combined autism and Asperger's under what's now known as autism spectrum disorder, ASD.

The change made the diagnosis for many more likely, but about one in three who would have been diagnosed with Asperger's in 2013 don't fall into the autism spectrum after the change.

And yet today, one in 36 children in the U.S. get diagnosed with ASD, up 400% from 20 years ago.

Grief after losing a loved one can, since the update, be diagnosed as major depression disorder and be treated with medication.

This pathologization of a normal state is highly controversial.

Perhaps we should be deeply saddened if we lose someone we love.

Disruptive mood dysregulation disorder, which many parents know as temper tantrums or angry outbursts, was added.

Psychiatrists who identify it in young children may now prescribe mood stabilizers, which in some cases can be the right treatment, but may have negative consequences, especially for those who don't need them.

ADHD, a condition that was studied originally only in boys, continues to include diagnostic criteria that do not suit girls or adults, both of whom may show different symptoms of it.

As a result, women are often treated for conditions they do not have, such as bipolar disorder.

While many doctors relying on the new DSM do help a lot of real patients with real problems, we have to ask, who else benefits?

Or, as the investor Charlie Munger liked to say, show me the incentive and I will show you the outcome.

The DSM is written, published and sold by the American Psychiatric Association, a non-profit organization whose 30,000 plus members are the very doctors who use the book in their daily practice.

Since the middle of the last century, doctors and pharmaceuticals have been working together to deliver treatments for people suffering from schizophrenia, depression and other mental health issues.

After all, both psychiatrists and businessmen wanted to cure the same patients, albeit perhaps for different reasons.

After some success and the development of the first antidepressant in the 1950s, the relationship between the two grew ever more cozy, leading to potential conflicts of interest.

In the 1970s, some drug makers funded a political action committee to help the psychiatrists lobby the US Congress to pass laws that ensure more public funds are spent on the awareness, research and treatment of mental health.

Pharmaceuticals also began sponsoring ghostwriting services and media training workshops, turning psychiatrists into renowned authors and speakers at the top medical schools around the world.

In 2008, a congressional investigation revealed that around 30% of the non-profit's annual budget was funded by the industry, primarily through advertising and medical education, which often claim that mental problems are the result of chemical imbalances one can fix with pills.

Even the content of the DSM, the very book used to diagnose and treat mental illnesses, appears to have been directly influenced by doctors, who not only cared for sick patients, but also had incentives aligned with the businessmen who sell drugs.

A widely cited paper revealed that 69% of the doctors overseeing the DSM-5 had ties to pharmaceutical companies.

In the Subcommittee for Sleep-Wake Disorders, a condition for which medication is the first-line treatment, 100% had financial ties to big drug-makers.

The global market for sleep disorder treatments is a $20 billion industry and growing fast.

But you tell us, since for certain conditions drugs are critical, is there a way to curb conflicts of interest between doctors and businessmen without killing expensive medical research projects that might bring us better treatments?

And how do you feel about fixed guidelines used to treat conditions that are extremely complex to assess?

Please share your thoughts in the comments below.

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