Why is the diagnostic and statistical manual of mental disorders so hard to revise?:path-dependence and “lock-in” in classification

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the D.S.M.-5, was published in May 2013. In the lead up to publication, radical changes to the classification were anticipated; there was widespread dissatisfaction with the previous edition and it was accepted that a “paradigm shift” was required. In the end, however, and despite huge efforts at revision, the published D.S.M.-5 differs very little from its predecessor. This paper considers why it is that revising the D.S.M. has become so difficult. The D.S.M. is such an important classification that this question is worth asking in its own right. The case of the D.S.M. can also serve as a study for considering stasis in classification more broadly; why and how can classifications become resistant to change? I suggest that classifications like the D.S.M. can be thought of as forming part of the infrastructure of science, and have much in common with material infrastructure. In particular, as with material technologies, it is possible for “path dependent” development to cause a sub-optimal classification to become “locked in” and hard to replace

What does hoarding tell us about mental health?

Rachel Cooper on classifying mental disorders and the DSM

Psychiatric classification and subjective experience

This article does not directly consider the feelings and emotions that occur in mental illness. Rather, it concerns a higher level methodological question: To what extent is an analysis of feelings and felt emotions of importance for psychiatric classification? Some claim that producing a phenomenologically informed descriptive psychopathology is a prerequisite for serious taxonomic endeavor. Others think that classifications of mental disorders may ignore subjective experience. A middle view holds that classification should at least map the contours of the phenomenology of mental illness. This article examines these options. I conclude that it is not true that phenomenology is a logical prerequisite for classification, nor even that classification should necessarily respect phenomenological boundaries, but that detailed phenomenological examination can sometimes inform classification

First do no harm?:what role should considerations of potential harm play in revising the D.S.M.?

Guidelines for revisions to D.S.M.-5 asked those proposing changes to consider potential harms to patients. This has been controversial. This paper argues that seeking to do no harm is appropriate when constructing a scientific classification scheme. I show that in many cases considerations of harm avoidance can play a role in influencing the design of the D.S.M. without the pursuit of scientific knowledge being compromised. I then turn to cases where compromise is required. Through a consideration of cases where lying is required to save lives I suggest that it is widely accepted that harm-avoidance can trump truth-telling. In extreme circumstances a psychiatric classification might thus set out to mislead in order to prevent harm