that the manual is ethnocentric and rests upon a narrow understanding of culture (e.g. The article reveals that, despite its attempt to adopt a more dynamic concept of culture, much of the critique that was raised against the Cultural Formulation of DSM-IV is still relevant for today’s version, i.e. In this article, I scrutinize this alleged attempt at making the manual more attuned to cultural differences. In their presentation of Cultural Concepts in DSM-5, the American Psychiatric Association (2013b) points out that the fifth edition “incorporates a greater cultural sensitivity throughout the manual,” a point that was also emphasised by the Task Force when the new manual was released (Kupfer et al. This led critics to raise their voice against what they saw as a decontextualisation of mental distress and an expanding medicalization of normal sadness (Cosgrove and Wheeler 2013 Frances 2013 Wakefield 2013 Whooley 2014).Įnding up somewhat in the shadows of the questions of neurobiology and medicalization, the manual also sought to advance its validity worldwide by being applicable across ethnic and cultural divisions. Another issue that hit the news was how DSM-5 got rid of the so called “bereavement exclusion” that existed in DSM-IV and that prevented people in grief after the loss of someone close from being diagnosed with Major Depression Disorder (Zisook et al. ![]() Among the major issues at stake was what impact current developments in neurobiology would have on the structure and content of the manual. With the aim of improving the previous manual, DSM–IV (1994), an exhaustive revision of concepts and criteria had been carried out since the beginning of the millennia. While acknowledging this view, proponents of the DSM stress that 'those who meet diagnostic criteria for these conditions experience distress or impairment and deserve appropriate intervention' (Nemeroff et al., 2013).In May 2013, the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published by the American Psychiatric Association (APA) after more than a decade’s intense discussion both within and outside the professional community engaged in mental health diagnosing. The ‘close relationship’ with anxiety disorders is still reflected by the sequential order of corresponding chapters in DSM-5 (Nemeroff et al., 2013).Īn emphasis − the potential advantage for clinical practice − of segregating PTSD and OCRDs from anxiety-related disorders, was to raise awareness amongst clinicians and the public, of these 'underdiagnosed and undertreated conditions', encouraging 'researchers to use structured diagnostic interviews and standardised symptom measures to investigate and evaluate the full range of these conditions in a systematic way' (Nemeroff et al., 2013).Ĭritics of the DSM continue to debate the definition and classification of ‘psychiatric disorders’ stressing that is important to avoid medicalising problems of daily living (Stein et al., 2010 Aftab, 2014). The decision was based on a review of evidence suggesting that OCD differs from anxiety disorders on a number of diagnostic validators and psychobiological and phenomenological overlap between OCD and some related conditions. A new PTSD subtype introduced for children aged 6 and under is considered to take into account the variation of symptom presentation in young children.ĭSM-5 also lists obsessive-compulsive disorder and related disorders (OCRDs) as a separate category (along with new conditions such as hoarding disorder and excoriation or ‘skin-picking’ disorder). ![]() war veterans and victims of crime or of abuse) often present for clinical assistance with such negative emotional states. DSM-5 has moved beyond the fear-based anxiety construct, and PTSD criteria have been revised to include negative emotional states and symptoms of distress – dysphoria, aggression, guilt and shame − on account that those with PTSD (e.g. PTSD has been traditionally conceptualised as a ‘fear disorder’ defined by three clusters of symptoms: (i) re-experiencing of fear (intrusive memories), (ii) avoidance of the reminders of trauma (amnesia, withdrawal, avoidance of situational reminders), and (iii) hyperarousal (disturbances in sleep, heightened startle response) (Nemeroff et al., 2013). Post-traumatic stress disorder (PTSD) and acute stress disorder have been moved from ‘Anxiety Disorders’ to an independent category of ‘Trauma and Stressor-Related Disorders’ or TSRD.
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