THE BRITISH PSYCHOLOGICAL ASSOCIATION RESPONSE TO DSM5 - JUNE 2011 - The Initial Response to the American Psychiatric Association: DSM-5 Development

DSM-5 2011

British Psychological Society response, June 2011

Page 1 of 26

Response to the American Psychiatric Association:

DSM-5 Development

The British Psychological Society thanks the American Psychiatric Association (APA) for the

opportunity to respond to the DSM-5 Development.

The British Psychological Society (“the Society”), incorporated by Royal Charter, is the learned

and professional body for psychologists in the United Kingdom. The Society is a registered

charity with a total membership of almost 50,000.

Under its Royal Charter, the objective of the Society is "to promote the advancement and

diffusion of the knowledge of psychology pure and applied and especially to promote the

efficiency and usefulness of members by setting up a high standard of professional education and

knowledge".

The Society is committed to providing and disseminating evidence-based expertise and advice,

engaging with policy and decision makers, and promoting the highest standards in learning and

teaching, professional practice and research. The Society is an examining body granting

certificates and diplomas in specialist areas of professional applied psychology.

We are content for our response, as well as our name and address, to be made public. We are

also content for the APA to contact us in the future in relation to this response. Please direct all

queries to:-

Consultation Response Team, The British Psychological Society,

48 Princess Road East, Leicester, LE1 7DR.

Email: consult@bps.org.uk Tel: (0116) 252 9508

This response was prepared on behalf of the Society by Professor Peter Kinderman, CPsychol,

AFBPsS, Chair of the Division of Clinical Psychology (DCP), with contributions from Susan van

Scoyoc, CPsychol, CSci, AFBPsS, committee member of the DCP and member of the Division of

Heath Psychology (DHP); Dr David Harper, CPsychol, AFBPsS, Professor David Pilgrim

CPsychol, AFBPsS, and Professor Richard Bentall, FBPsS, all members of the DCP; Lucy

Johnstone, CPsychol, AFBPsS, committee member of the DCP; Dr Amanda C de C Williams,

CPsychol, member of both the DCP and the DHP, and Professor Pamela James, CPsychol,

AFBPsS, committee member of the Division of Counselling Psychology. We would like to thank

Berry Neil for informing aspects of this response. We hope you find our comments useful.

Dr C A Allan, CPsychol, CSci, AFBPsS

Chair, Professional Practice Board

DSM-5 2011

British Psychological Society response, June 2011

Page 2 of 26

General comments

The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of

their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand

helping responses, but which do not reflect illnesses so much as normal individual variation.

We therefore do welcome the proposal to include a profile of rating the severity of different symptoms over the preceding month. This is

attractive, not only because it focuses on specific problems (see below), but because it introduces the concept of variability more fully

into the system. That said, we have more concerns than plaudits.

The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective

judgements, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect

current normative social expectations. Many researchers have pointed out that psychiatric diagnoses are plagued by problems of

reliability, validity, prognostic value, and co-morbidity.

Diagnostic categories do not predict response to medication or other interventions whereas more specific formulations or symptom

clusters might (Moncrieff, 2007).

Finally, disorders categorised as ‘not otherwise specified’ are huge (running at 30% of all personality disorder diagnoses for example).

Personality disorder and psychoses are particularly troublesome as they are not adequately normed on the general population, where

community surveys regularly report much higher prevalence and incidence than would be expected. This problem – as well as

threatening the validity of the approach – has significant implications. If community samples show high levels of ‘prevalence’, social

factors are minimised, and the continuum with normality is ignored. Then many of the people who describe normal forms of distress

like feeling bereaved after three months, or traumatised by military conflict for more than a month, will meet diagnostic criteria.

In this context, we have significant concerns over consideration of inclusion of both “at-risk mental state” (prodrome) and “attenuated

psychosis syndrome”. We recognise that the first proposal has now been dropped – and we welcome this. But the concept of

“attenuated psychosis system” appears very worrying; it could be seen as an opportunity to stigmatize eccentric people, and to lower

the threshold for achieving a diagnosis of psychosis

Diagnostic systems such as these therefore fall short of the criteria for legitimate medical diagnoses. They certainly identify troubling or

troubled people, but do not meet the criteria for categorisation demanded for a field of science or medicine (with a very few exceptions

such as dementia.) We are also concerned that systems such as this are based on identifying problems as located within individuals.

This misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our wellbeing

and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

DSM-5 2011

British Psychological Society response, June 2011

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The Society recommends a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence

that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most

strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any

classification system should begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.

Statistical analyses of problems from community samples show that they do not map onto past or current categories (Mirowsky, 1990,

Mirowsky & Ross, 2003). We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of

anxiety etc)? These would be more helpful too in terms of epidemiology.

While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their

problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients

often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a

diagnosis of ‘schizophrenia’ or ‘personality disorder’ may possess no two symptoms in common, it is difficult to see what communicative

benefit is served by using these diagnoses. We believe that a description of a person’s real problems would suffice. Moncrieff and

others have shown that diagnostic labels are less useful than a description of a person’s problems for predicting treatment response, so

again diagnoses seem positively unhelpful compared to the alternatives. There is ample evidence from psychological therapies that

case formulations (whether from a single theoretical perspective or more integrative) are entirely possible to communicate to staff or

clients.

We therefore believe that alternatives to diagnostic frameworks exist, should be preferred, and should be developed with as much

investment of resource and effort as has been expended on revising DSM-IV. The Society would be happy to help in such an exercise.

References

Mirowsky, John. 1990. "Subjective Boundaries and Combinations in Psychiatric Diagnosis." Journal of Mind and Behavior 11(3): 407-

24.

Mirowsky, John, and Catherine E. Ross. 2003. Social Causes of Psychological Distress, 2nd Edition. New Brunswick, N.J.: Aldine

Transaction

Moncrieff J (1995) Lithium revisited. “A re-examination of the placebo-controlled trials”. The British Journal of Psychiatry. 167: 569-573

Moncrieff, J (2003) “Clozapine v. conventional antipsychotic drugs for treatment-resistant schizophrenia: a re-examination”. The British

Journal of Psychiatry. 183: 161-166

Moncrieff, J (2007) The Myth of the Chemical Cure: a critique of psychiatric drug treatment. (1 vols). Palgrave MacMillan: Basingstoke,

Hampshire

Moncrieff J, & Kirsch I (2005) “Efficacy of antidepressants in adults”. BMJ 331 : 155 doi: 10.1136

Moncrieff, J & Timimi, S (2010) “Is ADHD a valid diagnosis in adults? No”. BMJ 2010; 340:c547 doi: 10.1136/bmj.c547

DSM-5 2011

British Psychological Society response, June 2011

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Comments on specific disorders

Code Title Comment

A 00-01

A 02-08

A 09

Intellectual Developmental Disorders

Communication Disorders

Autism Spectrum Disorder

We have no specific comments on these disorders, other than to say that, in our

opinion, the use of diagnostic labels has greater validity, both on theoretical and

empirical grounds in these areas.

A 10 Attention Deficit/Hyperactivity

Disorder

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

We have particular concerns about the inclusion of Attention Deficit/Hyperactivity

Disorder in this categorisation. Many of the concerns about the scientific validity and

utility of diagnoses per se (articulated above) apply to ADHD. We are very

concerned at the increasing use of this diagnosis and of the increasing use of

medication for children, and would be very concerned to see these increase further.

DSM-5 2011

British Psychological Society response, June 2011

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A 11 Other Specified Attention

Deficit/Hyperactivity Disorder

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

We have particular concerns about the inclusion of Attention Deficit/Hyperactivity

Disorder in this categorisation. Many of the concerns about the scientific validity and

utility of diagnoses per se (articulated above) apply to ADHD. We are very

concerned at the increasing use of this diagnosis and of the increasing use of

medication for children, and would be very concerned to see these increase further.

In addition, we have serious concerns about the widespread use of the ‘other’ or ‘not

otherwise specified’ categories, which, in this context, appear to exacerbate all the

problems of labelling with invalid diagnostic labels.

A 12-15

A 16-22

Learning Disorders (Learning

Disorder, Dyslexia, Dyscalculia,

Disorder of Written Expression), Motor

Disorders

We have no specific comments on these disorders, other than to say that, in our

opinion, the use of diagnostic labels has greater validity, both on theoretical and

empirical grounds in these areas.

DSM-5 2011

British Psychological Society response, June 2011

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B 00 Schizophrenia As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above are particularly relevant to the diagnosis of schizophrenia. We note in

particular, that the invalidity of this diagnosis is such that it is entirely possible for two

individuals with the diagnosis to share no characteristics or symptoms. We also note

the poor prognostic and therapeutic validity of this group of diagnoses.

B01 Schizotypal Personality Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above are particularly relevant to the diagnosis of Schizotypal Personality Disorder –

as it suffers from the problems associated with personality disorder more generally,

as well as problems associated with psychosis.

DSM-5 2011

British Psychological Society response, June 2011

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B02 Schizophreniform Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above are particularly relevant to the diagnosis of Schizophreniform Disorder, which

appears to be a reflection of vague concerns about a person’s mental health –

effectively one of many ‘catch-all’ classifications.

B03 Brief Psychotic Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above are particularly relevant to the diagnosis of Brief Psychotic Disorder, given the

problems associated with psychiatric labels, the particular consequences of a

psychotic label and the known transience of many of these fleeting psychosis-like

experiences.

DSM-5 2011

British Psychological Society response, June 2011

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B04 Delusional Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above apply equally to the diagnosis of Delusional Disorder.

B05 Schizoaffective Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above apply equally to the diagnosis of Schizoaffective Disorder.

DSM-5 2011

British Psychological Society response, June 2011

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B06 Attenuated Psychosis Syndrome As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

We have significant concerns over the inclusion of “attenuated psychosis syndrome”.

The concept of “attenuated psychosis system” appears very worrying; it looks like an

opportunity to stigmatize eccentric people, and to lower the threshold for achieving a

diagnosis of psychosis (and hence increasing the number the people receiving

antipsychotic medication and a range of other social ills).

B07-14 Substance-Induced Psychotic

Disorder

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems.

For psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The general concerns about the scientific validity and utility of diagnoses articulated

above are particularly relevant to the diagnosis of Substance-Induced Psychotic

Disorder. People take drugs; these drugs affect their mental state and can have

long-term consequences. That appears somewhat different from a diagnosis of

conventional medical illnesses.

DSM-5 2011

British Psychological Society response, June 2011

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B15 Psychotic Disorder Associated with a

Known General Medical Condition

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

These concerns include the association between physical and psychological health –

where we believe it is unnecessary and misleading to represent such associations as

‘psychiatric illnesses’ – and ‘catch-all’ classifications such as ‘unspecified’ or ‘other’.

B16 Catatonic Disorder Associated with a

Known General Medical Condition

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

These concerns include the association between physical and psychological health –

where we believe it is unnecessary and misleading to represent such associations as

‘psychiatric illnesses’ – and ‘catch-all’ classifications such as ‘unspecified’ or ‘other’.

B17 Other Specified Psychotic Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

These concerns include the association between physical and psychological health –

where we believe it is unnecessary and misleading to represent such associations as

‘psychiatric illnesses’ – and ‘catch-all’ classifications such as ‘unspecified’ or ‘other’.

B18 Unspecified Psychotic Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

These concerns include the association between physical and psychological health –

where we believe it is unnecessary and misleading to represent such associations as

‘psychiatric illnesses’ – and ‘catch-all’ classifications such as ‘unspecified’ or ‘other’.

DSM-5 2011

British Psychological Society response, June 2011

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B19 Unspecified Catatonic Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

These concerns include the association between physical and psychological health –

where we believe it is unnecessary and misleading to represent such associations as

‘psychiatric illnesses’ – and ‘catch-all’ classifications such as ‘unspecified’ or ‘other’.

C00-06 Bipolar and related disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These general concerns about the scientific validity and utility of diagnoses

articulated above apply equally to the area of bipolar disorder and related disorders.

DSM-5 2011

British Psychological Society response, June 2011

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D01-02

and

D04-09

Depressive Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These general concerns about the scientific validity and utility of diagnoses

articulated above apply equally to the area of depressive disorders. We note that, in

this context, sadness and unhappiness which are deserving of help and intervention

– are not best considered illnesses. We also note that, by regarding them as such,

there is a danger of misunderstanding their nature and cause and applying

inappropriate medical remedies.

DSM-5 2011

British Psychological Society response, June 2011

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D00 Disruptive Mood Dysregulation

Disorder

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These general concerns about the scientific validity and utility of diagnoses

articulated above apply equally to the area of depressive disorders. We note that, in

this context, sadness and unhappiness which are deserving of help and intervention

– are not best considered illnesses. We also note that, by regarding them as such,

there is a danger of misunderstanding their nature and cause and applying

inappropriate medical remedies.

We have particular concerns at the inclusion of this diagnosis, whose essential

characteristics: “...severe recurrent temper outbursts in response to common

stressors....” appear to reflect exactly those normative judgements referred to above.

DSM-5 2011

British Psychological Society response, June 2011

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D03 Chronic Depressive Disorder

(Dysthymia)

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These general concerns about the scientific validity and utility of diagnoses

articulated above apply equally to the area of depressive disorders. We note that, in

this context, sadness and unhappiness which are deserving of help and intervention

– are not best considered illnesses. We also note that, by regarding them as such,

there is a danger of misunderstanding their nature and cause and applying

inappropriate medical remedies.

We have particular concerns at the inclusion of this diagnosis, whose essential

characteristics: “...depressed mood for most of the day...” certainly reflects a state of

affairs that any humane individual should attempt to address, but does not appear to

reflect any form of medical illness.

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British Psychological Society response, June 2011

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E00-14 Anxiety Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

The concerns noted above also apply to anxiety disorders. We note that many

people have experienced, and live in, circumstances that reasonably induce normal

and understandable anxiety. We further note that many of the specific diagnoses –

particularly social anxiety and generalised anxiety disorder – appear, again, to reflect

conditions that are understandable, and deserving of help and intervention, but are

not best considered illnesses. We also note that, again, by regarding them as such,

there is a danger of misunderstanding their nature and cause and applying

inappropriate medical remedies.

F 00-09 Obsessive-Compulsive and Related

Disorders

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

Although obsessive-compulsive problems appear to have more empirical validity

than some other disorders, many of the concerns noted above also apply here –

particularly the concerns over inappropriate medicalisation and potential overreliance

on medical interventions.

DSM-5 2011

British Psychological Society response, June 2011

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G00-08 Trauma- and Stressor-Related

Disorders

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

Again, we have concerns in the area of trauma-related disorders. Obviously it is

right and proper to recognise the effects of traumatic events on people, and to be

able to offer appropriate help. In this context however, we fear that those benefits

might be made more difficult if, instead of recognising the effects of traumatic events

on people, these were considered to be ‘disorders’ or ‘illnesses’. As noted above,

there are more appropriate conceptualisations.

H00-05 Dissociative Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These concerns also apply to this area.

DSM-5 2011

British Psychological Society response, June 2011

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J00 Complex Somatic Symptom Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

Many of these concerns also apply to this area.

It is good to see the assumptions implicit in ‘somatization’ terminology have been

removed, but we retain concerns about the criteria used.

Concern about medical seriousness arises from the universal experience of pain as

a warning signal of something wrong, as in many acute pains. Until and unless an

adequate explanation is given to the person with persistent pain, distinguishing it

from the ‘alarm signal’ of acute pain, they continue to search for a medical

explanation as is the case in acute pain. “Reassurance” that nothing shows on

investigation often exacerbates the patient’s concerns that what they have is hard to

detect or diagnose. The judgment of what is ‘disproportionate’ or ‘excessive’ is a

subjective, value-laden, issue.

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British Psychological Society response, June 2011

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J01 Simple Somatic Symptom Disorder As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

Many of these concerns also apply to this area.

It is good to see the assumptions implicit in ‘somatization’ terminology have been

removed, but we retain concerns about the criteria used.

Concern about medical seriousness arises from the universal experience of pain as

a warning signal of something wrong, as in many acute pains. Until and unless an

adequate explanation is given to the person with persistent pain, distinguishing it

from the ‘alarm signal’ of acute pain, they continue to search for a medical

explanation as is the case in acute pain. “Reassurance” that nothing shows on

investigation often exacerbates the patient’s concerns that what they have is hard to

detect or diagnose. The judgment of what is ‘disproportionate’ or ‘excessive’ is a

subjective, value-laden, issue.

J02-06 Somatic Symptom Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

Many of these concerns also apply to this area.

DSM-5 2011

British Psychological Society response, June 2011

Page 19 of 26

K00-07 Feeding and Eating Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These concerns also apply to this area.

L00-01 Elimination Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These concerns also apply to this area.

DSM-5 2011

British Psychological Society response, June 2011

Page 20 of 26

M00-20 Sleep-Wake Disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

These concerns also apply to this area.

N00-10 Sexual Dysfunctions As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

All the comments made earlier apply also here.

Of particular concern are the subjective and socially normative aspects of sexual

behaviour. It is a matter of record that homosexuality used to be considered a

symptom of illness. The Society would not be able to support considering sexual

differences as symptoms of illness.

DSM-5 2011

British Psychological Society response, June 2011

Page 21 of 26

P00-03 Gender Dysphoria As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

All the comments made earlier apply also here.

Of particular concern are the subjective and socially normative aspects of sexual

behaviour. We are very concerned at the inclusion of children and adolescents in

this area. There is controversy in this particular area – the concept of a ‘diagnosis’ of

a ‘psychiatric disorder’ disputed.

Labelling people who need help as ‘ill’ may make supportive and therapeutic

responses more difficult.

DSM-5 2011

British Psychological Society response, June 2011

Page 22 of 26

Q00-07 Disruptive, Impulse Control and

Conduct Disorders

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

All the comments made earlier apply also here. Of particular concern are the

subjective and socially normative aspects of conformist behaviour. We are very

concerned that ‘headstrong’ behaviour is considered to be pathognomic of an illness

(in Oppositional Defiant Disorder). Many people – many governments – would like

children and citizens to be less defiant and more compliant. However, it is not a

symptom of illness to be defiant. It may be a social or psychological problem to be

addressed, but it may, in some circumstances, be a characteristic to be praised.

An ‘unspecified’ disruptive or impulse control disorder, in this context, is even more

subjective, value-laden, conceptually confused, and therefore worrying.

DSM-5 2011

British Psychological Society response, June 2011

Page 23 of 26

R00-31 Substance Use and Addictive

Disorders

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

We note with concern the concept of ‘Gambling Disorder’. Gambling is a problem,

and it is a social phenomenon and issue that requires study and response.

However, we feel it is conceptually wrong to regard this as an illness with symptoms.

We recognise that here – as in other ‘disorders’ – no concept of organic pathology is

necessarily implied (DSM-V is, we recognise, intended to be a useful list of

‘disorders’), but we also are aware that inclusion in such a list has implications, and

we strongly feel that an alternative non-medical conceptualisation is called for.

S00-35 Neurocognitive Disorders We have no specific comments on these disorders, other than to say that, in our

opinion, the use of diagnostic labels has greater validity, both on theoretical and

empirical grounds in these areas.

DSM-5 2011

British Psychological Society response, June 2011

Page 24 of 26

Personality disorders The Society has several concerns in this area.

While a hybrid dimensional-categorical model for personality and personality

disorder assessment and diagnosis may be welcome, little of that is visible.

As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

We are particularly concerned that the system proposes to diagnose psychiatric

disorder on a rating of “quite a bit” on personality trait domains.

DSM-5 2011

British Psychological Society response, June 2011

Page 25 of 26

U00-09 Paraphilias As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

All these comments apply also here. Again, of particular concern are the subjective

and socially normative aspects of sexual behaviour. It is a matter of record that

homosexuality used to be considered a symptom of illness. The Society would not

be able to support considering sexual differences as symptoms of illness.

We, finally, have severe misgivings about the inclusion of “Paraphilic Coercive

Disorder” in the appendix. Rape is a crime, not a disorder. Such behaviours can, of

course, be understood, but we disagree that such a pattern of behaviour could be

considered a disorder, and we would have grave concerns that such views may offer

a spurious and unscientific defence to a rapist in a criminal trial.

DSM-5 2011

British Psychological Society response, June 2011

Page 26 of 26

V01-06 Other disorders As stated in our general comments, we are concerned that clients and the general

public are negatively affected by the continued and continuous medicalisation of their

natural and normal responses to their experiences; responses which undoubtedly

have distressing consequences which demand helping responses, but which do not

reflect illnesses so much as normal individual variation.

We believe that classifying these problems as ‘illnesses’ misses the relational

context of problems and the undeniable social causation of many such problems. For

psychologists, our well-being and mental health stem from our frameworks of

understanding of the world, frameworks which are themselves the product of the

experiences and learning through our lives.

Clearly it is good for healthcare professionals and others to recognise self-harm.

However, we do not believe that self-harm should be classified as a symptom of a

disorder. Rather we would support recognising this behaviour, understanding it and

offering help.

Similarly, a “pattern of falsification of physical or psychological signs or symptoms, or

of induction of injury or disease” is a worrying and important phenomenon. But again

it should be understood and responded to, not conceptualised as a symptom of an

illness.