Psychiatric Manual Could Lead to Trouble

Personality disorders removed from diagnosis manual could have unintended consequences

January 27, 2012 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard which clinicians use to diagnose their patients. A new edition of the manual contains changes that may lead to omitting certain diagnoses.

The manual is published by the American Psychiatric Association (APA) in order to keep diagnoses consistent between clinicians worldwide. The changes are meant to make identifying personality disorders easier. However, a new study shows that these changes may cause some personality disorders to not be recognized at all.

"Ask your psychiatrist if the new manual effects your diagnosis."

Mark Zimmerman, M.D., Director of Outpatient Psychiatry at Rhode Island Hospital, points out that the changes are being made without sufficient research to back them up.

"When it comes to revising the official diagnostic classification system, the guiding principle should be that criteria should not be changed in the absence of research demonstrating that the new approach is superior to the old in either validity or clinical utility, preferably both,” says Zimmerman.

Four of the ten personality disorders are going to be removed from version 5 of the manual, abbreviated as DSM-5. The disorders to be removed are: paranoid, schizoid, histrionic, and dependent personality disorder.

To find out if the changes would lead to misdiagnosis Zimmerman and his team evaluated 2,150 psychiatric outpatients - 25% of which were diagnosed with 1 of the 10 personality disorders in the current manual. After re-diagnosing the outpatients using the new manual, DSM-5, 59 patients were not diagnosed with a personality disorder.

The disorders are being removed because there is overlap between the symptoms and many patients are diagnosed with more than one disorder. The result, however, is that some patients may not be diagnosed at all.

“The findings of the present study highlight our concerns about adopting changes in the diagnostic manual without adequate empirical evaluation beforehand. To be sure, there are problems with the classification of personality disorders, however, the identification of a problem is only the first step of a process resulting in a change to diagnostic criteria.”

The study was published in the Journal of Clinical Psychiatry on Jan. 24th, 2012.