For years, I fought for the right for us to use the DSM, obtain third party reimbursement, and practice independent of the medical profession. However, I am now not quite so sure. The problem is that-since my retirement from clinical practice-I have become a consumer advocate and have found numerous problems in the way DSM is used, which harms patients in the long run. Such incorrect diagnoses can be harmful in many ways. Some providers are quietly open in admitting that they use the DSM, only because it is the only way to get third party insurance to pay for their services.
Now, of course, psychiatrists are not necessarily immune from these practices. However, when one considers mental health practitioners, all claiming the right to diagnose mental illness, reducing the numbers who legitimately are able do so will be a safeguard to patients and help minimize abuse.
John A. At the same time, I am astounded, disappointed, and, dare I say, to a significant degree, offended by your remarks. My reaction is primarily to your suggestion that a Cautionary Statement be written along these lines: "This diagnostic manual is derived mainly from the expertise of psychiatrists. At the same time, such a statement strikes me as flagrantly dismissive and neglectful in recognition of the significant contributions of psychologists among other disciplines to the research and criteria upon which the DSM is built, not to mention the multidisciplinary approach to mental health care in the community.
The DSM is a multidisciplinary creation, and should be utilized in that same spirit. As a personality researcher, I will speak to the Axis II diagnostic system, although the contributions of psychologists to Axis I are just as intricately linked to the manual.
The proposed criteria for personality disorders which I hope the classification of personality disorders is recognized as useful to the mental health field are not only based on a body of research conducted by psychologists in coordination with psychiatrists, but are in fact actually written by psychologists some of whom I work with.
I would never suggest that a diagnostic system for mental illness be used without advanced clinical expertise. At the same time, I am nearly speechless at the level of disrespect to a large body of people who have contributed extraordinary efforts and lifetime career achievements to this field.
It is my profound hope that you would reconsider if not just your position on this issue, but at least your presentation of them to the greater community Jared DeFife, PhD Research Scientist Emory University Departmen tof Psychology www.
In fact, I would expect somebody from psychology or social work to protest strongly what I have said. DSM—5 will also be helpful in measuring the effectiveness of treatment, as dimensional assessments will assist clinicians in assessing changes in severity levels as a response to treatment.
Why was the traditional Roman numeral dropped from DSM? Since the research base of mental disorders is evolving at different rates for different disorders, diagnostic guidelines will not be tied to a static publication date but rather to scientific advances. These incremental updates will be identified with decimals, i.
When can DSM—5 be used for insurance purposes? However, the change in format from a multi-axial system in DSM-IV-TR may result in a brief delay while insurance companies update their claim forms and reporting procedures to accommodate DSM—5 changes. DSM—5 contains the most up-to-date criteria for diagnosing mental disorders, along with extensive descriptive text, providing a common language for clinicians to communicate about their patients. The ICD contains the code numbers used in DSM—5 and all of medicine, needed for insurance reimbursement and for monitoring of morbidity and mortality statistics by national and international health agencies.
How much did it cost to produce DSM—5? All of these funds came from APA's reserves and the association received no commercial or government funding for the development of DSM—5. APA is a non-profit organization representing psychiatrists and sees DSM—5 as an investment in the future of mental health allowing for more precise identification of mental disorders as well as facilitating new research.
We also jump too quickly to a psychiatric explanation with the elderly. Furthermore, the symptoms may have more to do with the staffing and nursing team than any other factor. So you have to understand the environmental factors that are involved before jumping to a diagnosis. The less classical the presentation, the younger or the older the patient, the likelier you are to get overdiagnosis and mistreatment with certain medication. Frances: I think the insurance industry has made a basic error by requiring a diagnosis for reimbursement on the first visit.
It would be much better if there were a period of time in which the physician would get paid for evaluating patients without diagnosing them. While that may seem like a potentially wasteful procedure, the current system is costlier in the long run. Once a person gets a diagnosis, it tends to stick for life.
It would be a lot cheaper in the long run to support more detailed evaluations than to have premature diagnoses that often lead to a lifetime of unnecessary treatment. The placebo response rate for most mild problems in life is 50 percent or more. Although patients may think the pill made them better, a lifetime of treatment can easily be based on a placebo effect. But this is America! Frances: I believe that the single biggest improvement we can make in the mental health system is to place more controls on drug company advertising.
Uniformly, when the diagnostic system gets loosened, the major economic effect is a dramatic increase in the sales of medications. And with the dramatic increase in sales of medications comes a tightening on the psychotherapy benefit. So as the diagnostic system gets looser, it paradoxically makes it harder for people to get psychotherapy because so much money gets funneled into the drug companies. Psychotherapists are mom-and-pop operations.
In the battle for the airwaves, the drug companies are in absolute control, in spite of the fact that psychotherapy for mild to moderate conditions is just as effective as drug treatment, with longer effects. A patient may need reimbursement for 12 therapy visits over three months. But if you step back and think about a lifetime of being on unnecessary medication, which could have been avoided if psychotherapy had been the initial treatment, the lifetime costs are much less to keep people away from medication.
What do you think of that decision? Frances: I think it makes absolute sense for NIMH to try to develop simpler questions and, instead of studying heterogeneous DSM diagnoses, to find simpler dimensions for study. But I was tremendously against the way it was announced, and the overall stress at NIMH, which is overpromising biological advances in psychiatric treatment.
The fact is that the brain is the most complicated thing in the universe. That means less of you trying to explain to each provider your challenges and more understanding. You may be entitled to a number of benefits or special services depending on your diagnosis.
We all are aware that mental health can impact your work, finances, housing, family, and social life. Many areas may be able to provide you with additional services to help your life function better.
The big kicker with most of these services, you must provide proof that you have a diagnosis. A diagnosis can lead to a greater understanding. Fully diving into and understanding what a diagnosis is, can be empowering and educational. Unexplained behaviors can now clearly be explained as a symptom of a diagnosis.
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