Turning healthy people into psychiatric patients

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Diagnoses of psychiatric conditions like ADHD have increased explosively in recent years. Dutch experts say boisterous or easily-distracted children are being wrongly labelled as patients, largely to make money for pharmaceutical companies. They are afraid the new internationally-used manual for psychiatry unnecessarily brands even more healthy people as sick.

In 2008, Professor Roel Verheul, an expert in the field of personality disorders, was proud to be asked to take part in the preparations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, in April this year, he and Canadian colleague John Livesley resigned from the personality disorder working group after having repeatedly criticized – to no avail - the contents of the US ‘bible of psychiatry’.

Guesswork
Professor Verheul’s main complaint is that the entries in DSM-5 are too complicated and fail to make diagnosis simpler. The danger is that psychiatrists will all apply their own sets of symptoms - precisely what the manual is supposed to prevent. He told Dutch TV programme EenVandaag:

“We’re concerned that it’s going to come down to guesswork, that different therapists will reach different diagnoses for the same patient.”

The manual also contains a large number of new symptoms which, according to Verheul, are not properly scientifically founded. He says they need to be supported by more empirical evidence before they are published.

Proliferation
Others have also warned of a proliferation of new psychiatric conditions, leading to people who have little wrong with them being classed as patients. Psychologist Laura Batstra of the University of Groningen says:

The number of psychiatric diagnoses and the use of medication have increased tremendously in recent years, in DSM-3 the number of diagnoses among adults was increased, in DSM-4 the same happened with children”.

The third and fourth editions were published in 1987 and 2000.

Since the year 2000, the number of children diagnosed with the concentration disorder ADHD has increased exponentially, as did the use of the anti-ADHD drug Ritalin. Batstra believes the vast majority of these children do not have a medical problem and are erroneously being made to take medication.

Inflation
Professor Verheul notes:

“You have to be careful of diagnostic inflation. For example, it’s understandable that 1 percent of the population can be diagnosed as schizophrenic or that 2 or maybe 3 or 4 percent of children can be diagnosed with ADHD. But if you broaden the criteria to the point where large groups of people are labelled with these conditions, you create a kind of inflationary process. This is making psychiatry less credible in many people’s eyes.”

Laura Batstra argues that the manufacturers of Ritalin have played a questionable role in the diagnosis of ADHD: 

“It’s really out of control. The pharmaceutical industry got in on the act and has been promoting the condition among girls. In DSM-5 the categories have been defined even more broadly, so I think it’s good that this is now being discussed.”

Concern
US research shows, moreover, that 72 percent of the specialists contributing to the manual have ties with the pharmaceutical industry. These ties vary from being paid as guest speakers at congresses to owning shares in drug companies. Speaking on EenVandaag, Batstra said this was a cause for concern: 

“We know, for instance, that research paid for by the pharmaceutical industry is five times more likely to describe the effects of medication positively than independent research.”

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is expected to appear next year.

(imm)