Boston Herald
Psychiatrist Allen Francis
Monday, March 22, 2010

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

Our panel tried hard to be careful, but inadvertently contributed to three false “epidemics” – attention deficit disorder, autism and childhood bipolar disorder. Our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

The first draft of the next edition of the DSM, posted for comment last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This could create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day.

The manual, prepared by the American Psychiatric Association, is psychiatry’s only official way of deciding who has a “mental disorder” and who is “normal.” The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two.

Where the DSM-vs.-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status – to say nothing of stigma.

What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (I, along with more than 6 percent of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

The recklessly expansive suggestions go on. “Attention deficit disorder” would become much more prevalent in adults, encouraging the already rampant use of stimulants. A category for temper could capture kids with normal tantrums.

The sexual disorders section is particularly adventurous. “Hypersexuality disorder” would bring great comfort to philanderers. “Paraphilic coercive disorder” introduces the dangerous idea that rapists merit a diagnosis of mental disorder if they get sexual excitement from raping.

Experts have an almost universal tendency to expand their own favorite disorders. This therapeutic zeal creates a huge blind spot to the great risks that come with unnecessary treatment.
Allen Frances is former chairman of psychiatry at Duke University.