Dsm 5 Quotes

Narcissistic personality disorder is named for Narcissus, from Greek mythology, who fell in love with his own reflection. Freud used the term to describe persons who were self-absorbed, and psychoanalysts have focused on the narcissist's need to bolster his or her self-esteem through grandiose fantasy, exaggerated ambition, exhibitionism, and feelings of entitlement.

The power to label is the power to destroy.

Acts of psychological abuse include berating or humiliating the victim; interrogating the victim; restricting the victim's ability to come and go freely; obstructing the victim's access to assistance (e.g., law enforcement; legal, protective, or medical resources); threatening the victim with physical harm or sexual assault; harming, or threatening to harm, people or things that the victim cares about; unwarranted restriction of the victim's access to or use of economic resources; isolating the victim from family, friends, or social support resources; stalking the victim; and trying to make the victim think that he or she is crazy.

Loose diagnosis is causing a national drug overdose of medication. Six percent of our people are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs.6

[W]ay too much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don't get treated for it, and many suffering with schizophrenia wind up in prisons. The writing is on the wall.

The great unspoken paradox of the arduous process of psychoanalysis is that the best patients are the ones who never really needed it in the first place. Abnormal

Taking a pill is passive. In contrast, psychotherapy puts the patient in charge by instilling new coping skills and attitudes toward life.

[W]e have far too much faith in pills, far too little trust in resilience, time, and homeostasis.

Great, so he was paranoid, too—which, along with his ambient anxiety and the narcissistic behavior he’d been popping lately, meant he had most of the DSM-IV covered tonight.

Time heals so well because many of our ills are short-term, situational, and self-limited - our bodies and our minds are programmed to be resilient without any active effort on our part.

First documented in the late 1800s, then “codified as an independent diagnostic entity” a century later, though largely comorbid with panic disorder. You can read all about it, if you like, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5 for short. It’s always amused me, that title; it sounds like a movie franchise. Liked Mental Disorders 4? You’ll love the sequel!

Mental disorders should be diagnosed only when the presentation is clear-cut, severe, and clearly not going away on its own. The best way to deal with the everyday problems of living is to solve them directly or to wait them out, not to medicalize them with a psychiatric diagnosis or treat them with a pill.

DSM-5 is not 'the bible of psychiatry' but a practical manual for everyday work. Psychiatric diagnosis is primarily a way of communicating. That function is essential but pragmatic—categories of illness can be useful without necessarily being 'true.' The DSM system is a rough-and-ready classification that brings some degree of order to chaos. It describes categories of disorder that are poorly understood and that will be replaced with time. Moreover, current diagnoses are syndromes that mask the presence of true diseases. They are symptomatic variants of broader processes or arbitrary cut-off points on a continuum.

DSM definitions do not include personal and contextual factors such as whether the depressive symptoms are an understandable response to loss, a terrible life situation, psychological conflict or personality factors.

You can read all about it, if you like, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5 for short. It’s always amused me, that title; it sounds like a movie franchise. Liked Mental Disorders

Overcoming problems on your own normalizes the situation, teaches new skills, and brings you closer to the people who were helpful. Taking a pill labels you as different and sick, even if you really aren't. Medication is essential when needed to reestablish homeostasis for those who are suffering from real psychiatric disorder. Medication interferes with homeostasis for those who are suffering from the problems of everyday life.

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

ADHD is spreading like wildfire. It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakable difficulties in many situations. Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify.

Patienthood can become a way of life and rationale for people who are struggling for other reasons.

Partner psychological abuse encompasses nonaccidental verbal or symbolic acts by one partner that result, or have reasonable potential to result, in significant harm to the other partner.

It is equally dangerous at either extreme - to have either an expanding concept of mental disorder that eliminates normal or to have an expanding concept of normal that eliminates mental disorder.

The DSMs have a mixed record. They have served an extremely valuable function in improving the reliability of psychiatric diagnosis and in encouraging a revolution in psychiatric research. But they have also had the very harmful unintended consequence of triggering and helping to maintain a runaway diagnostic inflation that threatens normal and results in massive overtreatment with psychiatric medication.

DSM-5 pathologized those who hold on to their stuff for too long, who clutter their homes too much, who do not clean that often, and who harbor too many things. The manual labeled these activities “hoarding disorder” (HD, as it is sometimes called) and gave them an International Classification of Diseases (ICD-9-CM, to be precise) code of 300.3. Legitimized as a psychiatric disease and categorized under Obsessive-Compulsive and Related Disorders, this diagnosis rendered unsound certain relations to certain personal property. Hoarding, it seems, had arrived.

The lifetime prevalence of dissociative disorders among women in a general urban Turkish community was 18.3%, with 1.1% having DID (ar, Akyüz, & Doan, 2007). In a study of an Ethiopian rural community, the prevalence of dissociative rural community, the prevalence of dissociative disorders was 6.3%, and these disorders were as prevalent as mood disorders (6.2%), somatoform disorders (5.9%), and anxiety disorders (5.7%) (Awas, Kebede, & Alem, 1999). A similar prevalence of ICD-10 dissociative disorders (7.3%) was reported for a sample of psychiatric patients from Saudi Arabia (AbuMadini & Rahim, 2002).

In the Judeo-Christian view--and thus, the dominant Western view--to die by suicide is a sinful, selfish act. This perception has been slow to fade, though the science is clear that suicide has root causes in diagnosable mental disorders and substance abuse. ("Sin" does not qualify for the DSM-5.) The cultural meaning of suicide in Japan is different. It's viewed as a selfless, even honorable act... Outsiders say that the Japanese romanticize suicide, and that Japan has a "suicide culture." But the reality is more complicated. The Japanese view of self-inflicted death as altruistic is more about wanting not to be a burden, rather than fascination with mortality itself.

Because DID requires the presence of amnesia, DID patients are, by DSM-5 definition (American Psychiatric Association, 2013), unaware of some of their behavior in different states. Progress in treatment includes helping patients become more aware of, and in better control of, their behavior across all states. To those who have not had training in treating DID, this increased awareness may make it seem as if patients are creating new self-states, and “getting worse,” when in fact they are becoming aware of aspects of themselves for which they previously had limited or no awareness or control. Although some DID patients create new self-states in adulthood, clinicians strongly advise patients against so doing (Fine, 1989; ISSTD, 2011; Kluft, 1989).

Let’s take a quick look at what a psychopath is. Although the American Psychiatric Association (APA) no longer uses this term, much of the rest of the world does. The APA has incorporated the term psychopath and sociopath within a broader definition designated as antisocial personality disorder. Even within the APA, there is wide disagreement as to what these terms actually mean. The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is an American handbook for mental health professionals. It lists different categories of mental disorders and the criteria for diagnosing them, according to the publishing organization, the American Psychiatric Association. The APA defines antisocial personality disorder, which would include Lobaczewski’s psychopathic personality disorder, as a pervasive pattern of disregard for the violation of the rights of others occurring since age fifteen years, as indicated by three or more of the following:   1.     Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest. 2.     Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3.     Impulsivity or failure to plan ahead. 4.     Aggressiveness, as indicated by repeated physical fights or assaults. 5.     Reckless disregard for the safety of self or others. 6.     Consistent irresponsibility. 7.     Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

We feel so superior to the dead. For example, if Michelangelo was so damn smart, why'd he die? How I feel reading the DSM is, I may be a fat stupid dummy, but I'm still alive. The caseworker's still dead, and here's proof that everything she studied and believed in all her life is already wrong. In the back of this edition of the DSM are the revisions from the last edition. Already, the rules have changed. Here are the new definitions of what's acceptable, what's normal, what's sane. Inhibited Male Orgasm is now Male Orgasmic Disorder. What was Psychogenic Amnesia is now Dissociative Amnesia. Dream Anxiety Disorder is now Nightmare Disorder. Edition to edition, the symptoms change. Sane people are insane by a new standard. People who used to be called insane are the picture of mental health.

Grassley ordered the APA to disclose how much of its income was drug money. The answer turned out to be a lot—according to the Times, nearly one-third of the organization’s $62.5 million annual revenue41 in 2006. Some of it came from advertising, but much of it went to educational programs in which drug companies tutored doctors attending APA conferences in the fine points of prescribing their drugs.

narcissistic personality disorder, or NPD. According to DSM-IV, NPD is distinguished by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy . . . , indicated by five (or more) of the following: 1. An exaggerated sense of self-importance . . . 2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love 3. Believes that he or she is “special” and can only be understood by, or should associate with, other special or high-status people . . . 4. Requires excessive admiration 5. Has a sense of entitlement . . . 6. Selfishly takes advantage of others to achieve his or her own ends 7. Lacks empathy 8. Is often envious of others or believes that others are envious of him or her 9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes

There presently exist three recognized conceptualizations of the antisocial construct: antisocial personality disorder (ASPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), dissocial personality disorder in the International Classification of Diseases (ICD-10; World Health Organization, 1992), and psychopathy as formalized by Hare with the Psychopathy Checklist—Revised (PCL-R; Hare, 2003). A conundrum for therapists is that these conceptualizations are overlapping but not identical, emphasizing different symptom clusters. The DSM-5 emphasizes the overt conduct of the patient through a criteria set that includes criminal behavior, lying, reckless and impulsive behavior, aggression, and irresponsibility in the areas of work and finances. In contrast, the criteria set for dissocial personality disorder is less focused on conduct and includes a mixture of cognitive signs (e.g., a tendency to blame others, an attitude of irresponsibility), affective signs (e.g., callousness, inability to feel guilt, low frustration tolerance), and interpersonal signs (e.g., tendency to form relationships but not maintain them). The signs and symptoms of psychopathy are more complex and are an almost equal blend of the conduct and interpersonal/affective aspects of functioning. The two higher-order factors of the PCL-R reflect this blend. Factor 1, Interpersonal/Affective, includes signs such as superficial charm, pathological lying, manipulation, grandiosity, lack of remorse and empathy, and shallow affect. Factor 2, Lifestyle/Antisocial, includes thrill seeking, impulsivity, irresponsibility, varied criminal activity, and disinhibited behavior (Hare & Neumann, 2008). Psychopathy can be regarded as the most severe of the three disorders. Patients with psychopathy would be expected to also meet criteria for ASPD or dissocial personality disorder, but not everyone diagnosed with ASPD or dissocial personality disorder will have psychopathy (Hare, 1996; Ogloff, 2006). As noted by Ogloff (2006), the distinctions among the three antisocial conceptualizations are such that findings based on one diagnostic group are not necessarily applicable to the others and produce different prevalence rates in justice-involved populations. Adding a further layer of complexity, therapists will encounter patients who possess a mixture of features from all three diagnostic systems rather than a prototypical presentation of any one disorder.

The categories used in psychiatric diagnosis are based on observation of signs and symptoms, rather than on pathological processes. One can make use of a few signs, such as facial expressions associated with depression or the flight of ideas associated with mania. But what clinicians mainly use for diagnosis are symptoms, the subject experiences reported by patients. Psychiatrists have little knowledge of the processes that lie behind these phenomena. Thus psychiatric diagnoses, with very few exceptions, are syndromes, not diseases.

What is actually observed in so-called 'biplar children'? If you read the research reports carefully, they describe broad and persistent emotional dysregulation. Although these children have mood swings, they do not develop manic or hypomanic episodes. They are moody, irritable, oppositional and likely to misbehave—like all children with disruptive behavior disorders. Their grandiose thinking usually consists of little beyond boastfulness. No evidence from genetics, neurobiology, follow-up studies or treatment response shows that this syndrome has anything in common with classical bipolarity.

Social (Pragmatic) Communication Disorder DSM-5 describes a new disorder that has elements of ASD but is actually conceptualized as outside the autism spectrum. The intention is to provide diagnostic coverage for children with symptoms in the social-communication domain but who have never displayed repetitive, restricted behaviours or interests. However, it is unclear how Social Communication Disorder (SCD) will be different from ASD, which support or therapy services will be available, and what the child will qualify for.

While large, impersonal orphanages provided children with minimal care and attention from an ever-changing series of nurses, children in loving foster families had available to them surrogate caregivers with whom they readily formed attachments. Children in foster care also demonstrated significantly less distress about the separation from their mothers, and they overcame their distress more readily when reunited with their own families. Therefore, it is not separation per se that is so devastating, but rather the extended stay in a strange, bleak or socially insensitive environment with little or no contact with the mother or other familiar figures.

Caffeine Use Disorder: Dependence on caffeine [This is not yet categorized as a formal disorder but is proposed for inclusion in Section III of DSM-5 as a condition requiring further research.27]

There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it.

DSM-5 has replaced this simple term with the new diagnostic category of Autism Spectrum Disorder Level 1, without accompanying intellectual or language impairment, a

correct citation for this book is American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022.

Diagnostic inflation has led to an explosive growth in the use of psychotropic drugs; this then produced huge profits that have given the pharmaceutical industry the means and the motive to blow up the diagnostic bubble into an ever-expanding balloon.

the drug companies had to get an indication for bipolar disorder and then they had to advertise a conception of bipolar disorder so broad as to be unrecognizable. Antipsychotics were soon being prescribed promiscuously, even by primary care physicians, to patients with garden-variety anxiety, sleeplessness, and irritability.

Much of the increased prevalence of ADHD results from the “false positive” misidentification of kids who would be better off never receiving a diagnosis. Drug company marketing pressure often leads to unnecessary treatment with medications that can cause the harmful side effects of insomnia, loss of appetite, irritability, heart rhythm problems, and a variety of psychiatric symptoms.

CBD has become the most inflated bubble in all of psychiatric diagnosis, with a remarkable fortyfold inflation in just one decade. CBD satisfied three essential preconditions for excessive popularity: a pressing need, influential prophets, and an engaging story.

DSM-5, the Diagnostic and Statistical Manual of Mental Disorders. “The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others.” Other relevant passages: “Failure to conform to social norms with respect to lawful behaviors”; “Reckless disregard for safety of self or others”; and “Lack of remorse.” In layman’s terms, she was a psychopath.

Manual of Mental Disorders, 5th Edition (DSM-5)—a person must be distressed by their drug use. In addition, the individual’s drug use must interfere with important life functions, such as parenting, work, and intimate relationships. This use must take up a great deal of time and mental energy and must persist in the face of repeated attempts to stop or cut back. Other symptoms that the person may experience include needing more of the drug to get the same effect (tolerance) and suffering withdrawal symptoms if use suddenly ceases.

DSM-5 personality disorder borderline patient, Vukovar.

which is essentially the bible of mental health: If it’s not in there, it ain’t real. There was an effort by a group of mental health experts to include it in the DSM-5, which was published in 2013, but the faceless arbiters of mental health behind the DSM—a group of psychiatrists I envision as a society of hooded figures chanting around a sacrificial child star—decided that it was too similar to PTSD. There was no reason to add a “C,” no need for a distinction between the two. It’s worth mentioning, however, that the U.S. Department for Veterans Affairs and the United Kingdom National Health Service both recognize C-PTSD as a legitimate diagnosis.

DSM rules specify that disorders cannot be added or dropped without conclusive empirical evidence. This is why lobbying to drop DID from DSM-5 was unsuccessful: there was no empirical foundation for such a change.

Problems with executive functions aren't explicitly mentioned in the DSM-5 as a symptom of autism, but I believe they're an essential part of the disorder. Executive functions oversee all kinds of processes in the brain, from self-control to executing complicated movements. People who have trouble with their executive functions struggle with dividing large tasks into smaller subtasks, separating important things from minor details and breaking patterns. You might have noticed how remarkable it is that some brilliant autistics aren't able to cook, eat on time or keep their houses tidy. Other autistics stick to the rules of the systems they have created for themselves so strictly, that even the smallest change can really upset them. They're two sides to the same problem: trouble with executive function.

we neglect what are the best forms of prevention—i.e., promoting exercise, proper diet, moderation in alcohol use, abstention from tobacco and drugs. These extremely useful and remarkably cheap prevention measures aren’t profitable for the medical-industrial complex and therefore lack its powerful and well-financed sponsorship.

DSM-IV unwittingly contributed to three new false epidemics in psychiatry—the overdiagnosis of attention deficit, autism, and adult bipolar disorder.

A ranting psychotic is far enough away from mean to be recognized as mentally sick by your aunt Tilly, but how do you decide when everyday anxiety or sadness is severe enough to be considered mental disorder? One thing does seem perfectly clear. On the statistical face of it, it is ridiculous to stretch disorder so elastically that the near average person can qualify. Shouldn’t most people be normal?

An injury collector, while not an official term listed in the DSM-5, is what some behaviorists call the narcissist who is unable to forgive and move on past the trauma or injury they suffered. Instead, they hold on to it, reliving the negative feelings associated with the injury, because it gives them something they relish. In

(DSM-5), created by the American Psychiatric Association, which catalogs symptoms as a means to a diagnosis—typically a “disorder,” which is genetic or “organic” in origin, not environmental or learned. By assigning a genetic cause, we naturally imagine our sickness to be part of who we are. When we become a diagnosis, it decreases incentive to change or try to explore root causes. We identify with the label. This is who I am.

The issue autistic people have fought for for years has finally been added – as the very last symptom on list B of the DSM-5. The one thing which, to me and many others, is the most important aspect of our autism: hypo- and/or hypersensitivity to stimuli. It’s the essence of the Intense World Theory and, in my opinion (and that of the Markrams), also the source of all additional problems. All people experience stimuli. Sometimes many, sometimes few, sometimes consciously, but frequently completely subconsciously. Stimuli are the signals we receive mainly through the five senses, even though humans actually have more than five. And then there’s the stimuli that come from your brain itself: thoughts.

We also know that ADHD can crop up for the first time in adulthood. This often happens when the demands of life exceed the person’s ability to deal with them. Classic examples are when a woman has her first baby or when a student starts medical school. In both instances the organizational demands of daily life skyrocket and the person shows the symptoms of ADHD that he or she had been able to compensate for in the past. It is then that ADHD can and should be diagnosed. Indeed, adult-onset ADHD is a recognized condition in the big book of psychiatric disorders, the Diagnostic and Statistical Manual (DSM-5).

According to DSM-5-TR, children 4 to 16 must show at least 6 out of 9 symptoms listed in the DSM-5-TR with apparent severity to be officially diagnosed. Who and where: A psychiatrist, a neurologist, a psychologist, a certified mental health professional, or a pediatrician must be the ones to make the diagnosis.

The DSM-5 defines depression as a person having multiple symptoms, which may include a depressed mood, loss of energy, diminished ability to concentrate, changes in appetite, and decreased interest or pleasure in normally enjoyable activities, for more than a two-week period. It also states that depression is disruptive, meaning that a person’s decreased mood is interfering with their ability to comfortably live their lives. A person with depression may have a lot of trouble getting out of bed in the morning, finishing basic tasks, or connecting with friends and family. One of my patients once described depression to me as what happens when life loses its color—and I think that’s a very illuminating description.

3. Paul Enright, “A Homeopathic Remedy for Early COPD,” Respiratory Medicine 105 (2011): 1573–75.

Some people, who never engaged in any research about DID, claim that there is no connection between child abuse and DID. Then they unwittingly contradict themselves by stating DID doesn’t even exist. DSM-5 concluded from the rigorous research into DID: “Interpersonal physical and sexual abuse is associated with an increased risk of dissociative identify disorder. Prevalence of childhood abuse and neglect in the United States, Canada and Europe among those with the disorder is close to 90%.

Nature abhors homogeneity and simply adores eccentric diversity.

What has typically happened over the past two hundred years is the slow emergence of a concept as a gradual, evolutionary exercise in collective wisdom: People see something in their patients that hadn’t occurred to them before; they write about it; others start seeing the same thing – for example, that some patients seem to be driven by a kind of furious rage – and slowly the concept emerges. But what comes out of this collective filtering is often a powerful notion, because lots of thoughtful people have endorsed it. (..) in the absence of actual science, the disease designers of the 1970s who produced DSM- 3 in 1980 settled for “consensus”: If a group of influential persons sitting about a table could agree that a disease existed, then it existed.

Do not routinely give the diagnosis of Panic Disorder solely because patients complain of nervous, anxious, panicky, or fearful emotions—the criteria for Panic Disorder are mainly physical symptoms that are also associated with increased blood levels of adrenaline (epinephrine), lactic acid, and increased blood pH. Even the “psychological” symptoms of derealization, depersonalization, and fears of dying, losing control, and going crazy can be reproduced by artificially altering blood adrenaline levels and acid/base balance.

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York: Guilford Press. [Step by step, this book helps the reader make sense of the interview material. Newly revised to reflect DSM-5 changes.]

exuberance.

I have no problem calling Donald a narcissist—he meets all nine criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—but the label gets us only so far.

Note that a loss of interest and pleasure in life is enough for a diagnosis of Major Depressive Episode—the presence of sadness, hopelessness, or depressed mood is not necessary.

Near-Psychotic Symptoms in Obsessive-Compulsive Disorder Despite clear-cut differences in psychopathology between schizophrenia and OCD, there is a substantial overlap, a “gray zone,” between the two disorders. Thus, unusual and “bizarre” obsessive themes exhibited by a subgroup of otherwise typical OCD patients might complicate the distinction between the obsessions and delusions. The difference between OCD-related pathologic slowness and the restrictive motor output associated with negative symptoms of schizophrenia or with catatonic motor disturbances is not straightforward. The differential diagnosis between OCD-related indecisiveness and pathologic doubt and schizophrenic ambivalence is also challenging. Patient insight into the senseless nature of OC symptoms is one of the hallmarks of the disorder. According to the DSM-5, at some point in the course of the illness, the patients must recognize that their obsessive beliefs are “definitely or probably not true.” Indeed, in typical OCD cases, patients readily acknowledge that their OC symptoms are illogical and pathologic. On the other hand, a significant majority of schizophrenia patients either do not believe that they are ill, or even if they do acknowledge symptoms, they misattribute them to other causes.6 Nevertheless, a significant subset of OCD patients can sometimes present without insight, or with conviction that their obsessions are true, thus complicating the differential diagnosis of obsessions from delusions. Overall, from the psychopathologic perspective, schizophrenia and OCD are distinct, despite their partially overlapping characteristics. Some symptoms, such as delusions and obsessions, pathologic doubt and ambivalence, rituals and motor stereotypy, may represent a continuum of OCD impairments, while others, such as negative and disorganized symptoms, are more schizophrenia-specific (Fig 3.1).

Elusive reality does not discourage Umpire Two. We don’t have to fully perceive or understand the underlying nature of our world to negotiate it well. Our senses and reasoning powers evolved as they did because they work just fine in the everyday, nonphilosophical business of survival. Mental constructs of reality are imperfect, but indispensable, ways to organize the otherwise bewildering phenomena of the world.

I sometimes joke that the only way to define mental disorder is “that which clinicians treat; researchers research; educators teach; and insurance companies pay for.

It is good to know and use the DSM definitions, but not to reify or worship them.31,32

Disease mongering cannot occur in a vacuum—it requires that the drug companies engage the active collaboration of the doctors who write the prescriptions, the patients who ask for them, the researchers who invent the new mental disorders, the consumer groups that advocate for more treatment, and the media and Internet that spread the word.

Most recently, the DSM-5 has been shown to have unacceptably low inter-rater agreement for several common disorders, including major depressive disorder (Regier et al., 2013

Diagnostic classification systems, such as the American Psychiatric Association’s Diagnostic and Statistical Manual (known as DSM-5), outline symptoms and guidance for clinical professionals who diagnose psychiatric disorders. Although the standard assessment of criminal psychopathy using the Hare criteria is as, if not more rigorous than traditional psychiatric diagnostic assessments based on classification systems such as DSM-5, psychopathy is not included as a formal diagnosis in these systems. Instead, the DSM-5 has a diagnostic category called antisocial personality disorder, which refers to individuals who violate societal norms and rights of other people.

20 years, we have experienced three unanticipated fads partly precipitated by DSM-IV: a 20-fold increase in Autism Spectrum Disorder,7 a tripling of Attention-Deficit/Hyperactivity Disorder (ADHD),8 and a doubling of Bipolar Disorders.9 The most dangerous fad is a 40-fold increase in childhood Bipolar Disorders,10 stimulated, not by DSM-IV, but instead by reckless and misleading drug company marketing. Twenty percent of the U.S. population11 is taking a psychotropic drug; 7% is addicted to one; and overdoses with legal drugs now cause more emergency room visits than overdoses with illegal drugs.

Retrospective epidemiological studies report that 20% of the general population qualifies for a current psychiatric diagnosis and 50% for a lifetime one.4 Prospective epidemiological studies double these rates and suggest that mental disorder is becoming virtually ubiquitous.5, 6 During the past

Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.

In this chapter I restrict myself to exploring the nature of the amnesia which is reported between personality states in most people who are diagnosed with DID. Note that this is not an explicit diagnostic criterion, although such amnesia features strongly in the public view of DID, particularly in the form of the fugue-like conditions depicted in films of the condition, such as The Three Faces of Eve (1957). Typically, when one personality state, or ‘alter’, takes over from another, they have no idea what happened just before. They report having lost time, and often will have no idea where they are or how they got there. However, this is not a universal feature of DID. It happens that with certain individuals with DID, one personality state can retrieve what happened when another was in control. In other cases we have what is described as ‘co-consciousness’ where one personality state can apparently monitor what is happening when another personality state is in control and, in certain circumstances, can take over the conversation.

[T]he DSM alone does not establish standards. Physicians, other mental health workers, drug companies, advocacy groups, school systems, the courts, the Internet, and cable TV all get to vote on how the written word will actually be used and misused.

The technical skills of medicine are becoming increasingly routine and may soon be done better by computer programs - but the shamanic skills of medicine will always be important to patients and to society.

We don't have to fully perceive or understand the underlying nature of our world to negotiate it well. Our senses and reasoning powers evolved as they did because they work just fine in the everyday, nonphilosophical business of survival. Mental constructs of reality are imperfect, but indispensable, ways to organize the otherwise bewildering phenomena of the world.

Our classification of mental disorders is no more than a collection of fallible and limited constructs that seeks but never finds the truth - but this remains our best current way of communicating about, treating, and researching mental disorders. [...] It is good to know and use the DSM definitions, but not to reify or worship them.

Psychiatric disorder consists of symptoms and behaviors that are not self-correcting - a breakdown in the normal homeostatic healing process. Diagnostic inflation occurs when we confuse the typical perturbations that are part of everyone's life with true psychiatric disorder[.]

Some radical critics of psychiatry have seized on its definitional ambiguities to argue that the profession should not exist at all. They take the difficulty in finding a clear definition of mental disorder as evidence that the concept has no useful meaning - if mental disorders are not anatomically defined medical diseases, they must be "myths," and there is no real need to bother diagnosing them. [...] This shibboleth can be believed only by armchair theorists with no real life experience in having, living with, or treating mental illness. However difficult to define, psychiatric disorder is an all-too-painful reality for those who suffer from it and for those who care about them.

[D]iagnosis needed to rest in order to let research catch up. It made no sense to keep rearranging the furniture of descriptive psychiatry, creating new diagnoses or altering the thresholds of existing ones, based only on the whims of the experts who happened to be in the room. [...] Changes in diagnoses should be few and far between until we gained much deeper understanding of what causes the mental disorders and how best to define and treat them.

We should not have the ambition to label as mental disorder every inconvenient or distressing aspect of childhood.

The definitions of mental disorder generally require the presence of distress, disability, dysfunction, dyscontrol, and/or disadvantage. This sounds better as alliteration than it works as operational guide. How much distress, disability, dysfunction, dyscontrol, and disadvantage must there be, and of what kind? [...] Not having a useful definition of mental disorder creates a gaping hole at the center of psychiatric classification, resulting in two unanswered conundrums: how to decide which disorders to include in the diagnostic manual and how to decide whether a given individual has a mental disorder.

Others argue that an increasingly demanding society is exposing previously subclinical ADHD symptoms. As performance standards are ratcheted up and external stimulation becomes nonstop and blaring, previously well-adapted individuals with mild ADHD may now be reaching a clinically significant level of impairment that qualifies as a mental disorder and requires treatment. My point back is that the difficulties people have in meeting society's expectations should not all be labeled as mental disorders. [...] If we, as a society, choose to help people enhance their performance to meet (perhaps excessive) demands, this should be an open policy decision - not one cloaked under medical auspices, done by medical prescription, and enhanced by drug company marketing.

[M]onolithic opposition to psychiatry is far too undiscriminating in its broadside critique. Indeed, it seems to me equally impossible to be enthusiastically an uncritical psychiatric loyalist or a dedicated psychiatric debunker. Both positions miss the truth in their one-sided extremity. [...] The antipsychiatry movement, generalizing from worst cases [...], goes way overboard and condemns all of psychiatry. Their extremism would deprive those who really need treatment and can benefit greatly from it.

Labels can also create self-fulfilling prophecies. If you are told you are sick, you feel and act sick, and others treat you as if you are sick.

Dependence” itself is pathologized, when, as we’ve seen, dependence isn’t the real problem in addiction: compulsive and destructive behavior is. (And indeed, the DSM-5, published in 2013, recognizes this, replacing “dependence” with “moderate to severe substance use disorder.”)

[E]ligibility for disability and other benefits should depend more on the person't actual level of functional impairment, less on whether or not he has a psychiatric diagnosis.

We need either to get the primary care doctors out of psychiatry or to teach them how to do it and give them sufficient time to do it properly.