Abstract
We are not likely to find a diagnostic system as “unethical,” per se, but rather find that it creates ethical concerns in its formulation and application. There is an increased risk of misuse and misunderstanding of the DSM-5 particularly when applied to forensic assessment because of documented problems with reliability and validity. For example, when field tested, the American Psychiatric Association reported diagnostic category kappa levels as acceptable that were far below the standard level of acceptability. The DSM-5 does not offer sensitivity and specificity levels and thus psychologists must keep this in mind when using or teaching this manual. Also, especially in light of concerns about diagnostic inflation, we recommend that psychologists exercise caution when using the DSM-5 in forensic assessments, including civil and criminal cases. Alternatives to the DSM-5, such as the International Classification of Diseases and the Psychodynamic Diagnostic Manual are reviewed.
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References
American Psychological Association. (2013). Ethical principles of psychologists and code of conduct. Retrieved from http://apa.org/ethics/code/index.aspx
Batstra, L., & Frances, A. (2012). Diagnostic inflation: causes and a suggested cure. The Journal of Nervous and Mental Disease, 200, 474–479.
Bornstein, R. F., & Gordon, R. M. (2012). What practitioners want in a diagnostic taxonomy? Comparing the PDM with DSM and ICD. Division/Review: A Quarterly Psychoanalytic Forum, Fall, 6, 35.
Brauser, D. (2012). DSM V field trials generate mixed results. Medscape News, May 8. Available from: http://www.medscape.com/viewarticle/763519. Accessed 2 April 2013.
Cosgrove, L., & Krimsky, S. (2012). A comparison of DSM-IV and DSM V panel members’ financial associations with industry: a pernicious problem persists. PLoS Medicine, 9(3), e1001190. doi:10.1371/journal.pmed.1001190
Cosgrove, L., & Wheeler, E. (2013). Drug firms, the codification of diagnostic categories, and bias in clinical guidelines. Journal of Law and Medical Ethics, 14(3), 644–653.
Evans, S. C., Reed, G. M., Roberts, M. C., Esparza, P., Watts, A. D., Correia, J. M., et al. (2013). Psychologists’ perspectives on the diagnostic classification of mental disorders: results from the WHO-IUPsyS Global Survey. International Journal of Psychology, 48(3), 177–193. doi:10.1080/00207594.2013.804189
Frances A. (2012). Newsflash from APA meeting: DSM 5 has flunked reliability test [Blog post]. Psychology Today. Available: http://www.psychologytoday.com/blog/dsmv-in-distress/201205/newsflash-apa-meeting-dsm-v-has-flunked-its-reliability-tests. Accessed 30 June 2013.
Gordon, R.M. (2007). PDM valuable in identifying high-risk patients. The National Psychologist, 16, 6, November/December, page 4. Available: http://www.mmpi-info.com/pdm-valuable-in-identifying-high-risk-patients
Insel TR: Director’s Blog [Internet]. (2013). Available from: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Accessed May 2013.
Karson, M. (2010). Bayes’ theorem and the DSM: Is it a book of definitions or a book of tests? WebPsychEmpiricist., Retrieved from http://wpe.info/papers_table.html. Accessed 1 June 2010
Landis, J. R., & Koch, G. G. (1977). "The measurement of observer agreement for categorical data". Biometrics, 33(1), 159–174. doi:10.2307/2529310. 10.2307%2F2529310 . JSTOR 2529310. PMID 843571.
Loewenstein, G., Sah, S., & Cain, D. M. (2012). The unintended consequences of conflict of interest disclosure. JAMA, 307, 669–670.
National Research Council. (2011). Clinical practice guidelines we can trust. Washington, DC: The National Academies Press.
Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. The American Journal of Psychiatry, 170(1), 59–70.
Reiger quote from: M. Elias, “Conflicts of interest bedevil psychiatric drug research,” USA Today, June 3, 2009.
Ronson, J. (2011). Bipolar kids: victims of the ‘madness industry’? New Scientist, 210(2815), 44–47.
Sah, S., & Fugh-Berman, A. (2013). Physicians under the influence: social psychology and industry marketing strategies. Journal of Law Medicine and Ethics, 41(3), 665–672.
Spitzer, R. L., Williams, J. B. W., & Endicott, J. (2012). Standards for DSM-5 reliability. American Journal of Psychiatry, 69, 537.
Task Force, P. D. M. (2006). Psychodynamic diagnostic manual. Silverspring, MD: Alliance of Psychoanalytic Organizations.
The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry 2013 Edition Retrieved from: http://www.psychiatry.org/practice/ethics/resources-standards
Westen, D., Defife, J. A., Bradley, B., & Hilsenroth, M. J. (2010). Prototype personality diagnosis in clinical practice: a viable alternative for DSM V and ICD-11. Professional Psychology Research and Practice, 41(6), 482–487.
Young, G. (2011). Development and causality: Neo-Piagetian perspectives. New York, NY, US: Springer Science and Business Media.
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Gordon, R.M., Cosgrove, L. Ethical Considerations in the Development and Application of Mental and Behavioral Nosologies: Lessons from DSM-5. Psychol. Inj. and Law 6, 330–335 (2013). https://doi.org/10.1007/s12207-013-9172-9
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DOI: https://doi.org/10.1007/s12207-013-9172-9