Psychiatrists criticize new US diagnosis manual

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German psychiatrists criticize the new edition of the US diagnosis manual for mental illnesses

Renowned neurologists and psychiatrists criticize the American Psychiatric Association's (APA) new mental illness handbook. In this context, they speak of an "almost inflationary use of diagnoses of mental disorders". According to the handbook, grief over the loss of a loved one that lasts longer than two weeks is a mental illness worthy of treatment because the feeling of grief then leads to depression.

Is there an "inflation of diagnoses"? Psychiatrists and psychotherapists in Germany criticize the new US manual. It says, among other things, that “prolonged grief” leads to an illness. If sadness, loss of appetite, poor concentration and apathy persisted for more than 14 days after a bereavement, the new diagnostic system speaks of a depressive episode that should be treated.

The new edition of the American Psychiatric Association's (APA) disease catalog is due to be published in May this year. It is now the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 for short. According to a prior publication, doctors and psychotherapists are advised to consider depressed mood after a loved one's death after 14 days as a possible depression and treat. So far, grief over the loss of a loved one has been an emotional exception.

Renowned psychiatrists critique new edition of the manual
Respected psychiatrists such as Allen Frances from Duke University in the United States have been warning of an inflation in diagnoses of mental illness for some time. Following the publication of the preliminary information, the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) has also interfered in the debate. According to the psychiatrists, the "US manual is not a direct guideline for the work of psychiatrists in Germany", but it could have an indirect influence on the reissue of the classification system of diseases by the World Health Organization. The classification is also known in Germany as ICD-10 and is essential for diagnostics.

DGPPN President Wolfgang Maier from the University of Bonn and his colleagues Peter Falkai from Munich and Andreas Heinz from the Berlin Charité criticize the topic of grief that the DSM-5 “the generally natural easing of the feeling of grief and the mostly preserved ability for self-regulation “Disregard. This could lead to a number of patients being wrongly diagnosed with "mental disorder". According to the psychiatrists, this in turn could mean that patients with pronounced mental disorders no longer receive adequate help.

Another point of criticism is the worsening of memory in old age, which also gets a disease value in the DSM-5 with undramatic courses. Here there is the new diagnosis "minor neurocognitive disorder" (minor mental malfunction). There is no "effective therapy" here and that is why, according to the critics, it is not correct to consider "forms of forgetfulness" as a disease.

In the crosshairs of criticism is also the so-called "substance use disorder". This diagnosis is a “collective diagnosis” for addictions, which summarizes the harmful use of stimulants and a real dependency. With this new form of diagnosis, medical professionals fear that the boundary between alcohol consumption could lead to social problems that are mixed with real addiction.

However, the critics of the DGPPN emphasize that some of the diagnoses listed in the DSM-5 "have no disease value and are part of normal life". The experts were also able to gain something positive from the manual. There are complaints that are no longer listed as a separate disease in the new edition. This also includes the so-called “burnout syndrome”, which is well received in the media in Germany. Rather, the “exhausted syndrome” is a depression. In the performance society, however, "burn-out" is preferred because this also suggests high performance. (sb)

Image: Gerd Altmann /

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