A2 Psychopathology: The DSM V, I mean 5, might be “finished” but the debate continues

A2 Psychology: Psychopathology

To mark the DSM-5’s “finalised” status (due for release May 2013) science blogger Neuroskeptic tweeted (@Neuro_Skeptic) a reminder of the controversies and debate circulating the revision of this particular psychiatric diagnostic tool originally shared in a the post – DSM-5. RIP? – back in August (2012).

Issues of diagnosis and classification

drugsHailing the release of the DSM-5 a “flop” and highlighting issues such as over-medicalisation and the impact of false-positive diagnoses on clinical trials for treatments (due to increased placebo effects when participants do not actually have the disorder being targeted by the treatment; see earlier post discussing the issue of mis-diagnosis), the post makes a useful addition to any A2 Psychology students reading list, regardless of the disorder selected for study in Unit 4 (AQA A, Psychopathology).

Critical thinking

A2 Psychology students could consider counter arguments to those posed in the piece in order to develop their analytical skills, they might also like to bear in mind that if clinicians don’t have to use this version then this in itself creates issues regarding the reliability and validity of diagnosis when a variety of diagnostic tools are employed (this can be linked to the issue that whilst the ICD tends to be used in the UK, the DSM is favoured in the US). 

Moving with the times

No more Roman Numerals

One of the ways in which the DSM has been “modernised” is that the Roman numerals have been dropped as a way to distinguish each edition. The old system was regarded as quite restrictive and future revisions will be referred to as 5.1, 5.2 etc.

Possible name change for schizophrenia?

In my research for this post I came across a couple of articles discussing the DSM, including a published paper addressing a possible name change from Schizophrenia to “Salience syndrome”  in the fifth edition of the DSM. I am unsure whether this is going to be a feature of the new diagnostic tool when it is released in May but this interested me greatly and I think it would make for an interesting discussion in the classroom.

According to the sources I have come across the motivation is not reducing social stigma but addressing misconceptions and the misleading nature of the name within clinical practice as well as society generally. It could be argued that continuing to refer to the disorder inaccurately as a “split brain” may be damaging and it would be more appropriate to rename the disorder to reflect its nature as we understand it now and leave the historical untruths in the past.

Students could be asked to come up with a new name and asked to debate whether this change is necessary. In order to contribute to this discussion students would need to…:

  • have a sound understanding of the nature of the disorder and its clinical characteristics
  • have a sound understanding of the explanations of the disorder in order to consider where the disorder comes from, if it is a “disorder” at all and its classification
  • have an awareness of how the disorder is perceived in society, the social stigma and the impact of the disorder on individuals with the diagnosis and those around them

Clearly the first 2 on this list are in the spec and the 3rd is just good knowledge to have in “real life”. Students might also consider the name as a source of bias and its possible influence on taking a scientific approach to studying Schizophrenia. Although students are unlikely to write about this issue in an exam, it offers a great way to develop being synoptic and making links. Used as an assessment activity a discussion of this nature is a good way to identify which students have a shaky understanding of the basic concepts in the spec, if your chosen disorder is Schizophrenia.

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