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DSM-4 Task Force Chairman Advises Caution With DSM-5

FRIDAY, May 17 (HealthDay News) -- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has introduced several high-prevalence diagnoses at the boundary of normality which is likely to lead to considerable false-positive rates and unnecessary treatment, according to an article published online May 17 in the Annals of Internal Medicine.

Noting that although the DSM-IV tried to prevent diagnostic inflation by discouraging changes and limiting new diagnoses, the rates of certain disorders increased more than 20-fold over 20 years, Allen Frances, M.D., from Duke University in Durham, N.C., discusses the issues relating to the publication of the DSM-5.

The author notes that several high-prevalence diagnoses at the boundary of normality were introduced to the DSM-5. These changes are likely to lead to considerable false-positive rates and unnecessary treatment, with high associated costs and potentially harmful side effects. The DSM-5 seems to have been prepared without adequate consideration of risk-benefit ratios or the economic cost of expanding the reach of psychiatry.

"I believe that the American Psychiatric Association's financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product," Frances writes. "My advice to physicians is to use the DSM-5 cautiously, if at all. It is not an official manual; no one is compelled to use it unless they work in an institutional setting that requires it."

Frances is the author of two books criticizing the DSM-5.

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