DSM 5 – Misdiagnosing or Mislabeling of Medical Diseases

The psychiatric world is close to receiving an updated version of their “Bible.” Officially known as the DSM 5 this tome, published by the Association of Psychiatrists,  under goes revision every couple of decades often accompanied by contentious issues and rancor from psychiatrists, psychologists and patient groups as ideology changes. Most diagnoses do not have an objective means of diagnosis and depend on subjective characteristics defined by committee. 

One of the biggest critics of the current DSM 5 is psychiatrist Dr. Allen Frances who chaired a previous edition.  Prominent in the news has been the changing of the definition of autism and the inclusion of bereaved people under depression, but there are other issues that have received less time in the spotlight.  

But, Frances also highlights the issue of mislabeling medical illness as a mental disorder. Less well known perhaps is a quiet backwater group focusing on the intersection between disease and psychosocial issues. Once labeled psychosomatic illnesses, the group now focuses on whether patients are too worried about being ill and the criteria are rather broad according to critics.  Frances, in a recent column, argues that there are two issues: encouraging a quick jump to the erroneous conclusion that someone's physical symptoms are 'all in the head' and mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.

Frances then quotes a source as saying, “One in six cancer and coronary disease patients met the criteria for DSM-5 'Somatic Symptom Disorder.' Do we really want to burden and stigmatize seriously ill people with an additional diagnosis of mental illness, just because they are worried about being sick and are vigilant about their symptoms?

Another issue may be whether medical patients labeled with psychiatric diagnoses get the same quality and type of care offered to patients without such a label. A recent Australian study notes psychiatric patients with a cancer diagnosis were less likely to receive specialized cancer treatments compared with the general population. The authors concluded "These results could suggest inequitable access to appropriate care, especially given that reduced access to treatment persisted after controlling for the presence of metastases." 

Image by Stephen Cummings via Flickr