Latest Edition of Psychiatry's 'Bible' Launched Amid Controversy
Authors say it defines disorders more concisely; critics say it will lead to over-diagnosis and unnecessary treatments
Lieberman called the DSM-5 "a reflection of the state of our scientific knowledge," and strongly disagreed with the notion that over-diagnosis and overmedication will be the end result of the manual's new standards.
"This doesn't reflect any expansion of the people who would be diagnosed. It just classifies them in a more concise and accurate way," he said. "The goal of the DSM is not to expand the number [of people] who receive diagnoses who don't warrant them. The reality is that there is tremendous under-treatment of people with real needs, and this new revision will help."
Reflecting on the strong reaction to the changes, Lieberman said it may go hand-in-hand with the public's uneasiness with mental illness.
"I think there's a strong stigma factor associated with mental illness," he said. "There are people who are either fearful of it or want to minimize its existence. That stigma has been historic, but it has been diminishing with greater education and research and better treatment."
For his part, Frances ascribes nothing but good intentions to those who worked on the new DSM, but is concerned that their efforts will lead to bad outcomes.
"The people who are suggesting these changes are experts in their field who are pure of heart, but they have made terrible decisions because they don't understand that new diagnoses that may work well for them can be an absolute disaster in everyday care, especially when drug companies get their hands on them," he said.
Frances has written a new book, Saving Normal, in which he argues that mental illness is over-diagnosed in America. He urged both parents and clinicians to be skeptical when it comes to the DSM-5 and any diagnoses that spring from it.
"My advice to physicians is to use the DSM-5 cautiously, if at all," Frances concluded in his commentary. "It is not an official manual; no one is compelled to use it unless they work in an institutional setting that requires it."