The DSM-IV has been used by the medical community and long term disability ERISA insurers trying to define mental disorders since the year 2000, so changing over to the DSM-V was no small task. However, it was a change that many welcomed because of a number of problems – both perceived and real – with the DSM-IV. Whether or not the relatively small changes made in DSM-V will actually fix the issues that bothered people about the previous Diagnostic Manual remains to be seen, but there were plenty of reasons to want to move on from the DSM-IV.
Problems with the DSM-IV
The reasons that disability insurers moved from using the DSM-IV to diagnose mental issues are many and varied, just as they were for the American Psychiatric Association. Here are just a few of the most common reasons cited as things that needed to be fixed.
- Listed treatments in the DSM-IV were seen as not specific or helpful enough.
- Diagnosing people using the DSM-IV led to extremely high rates of comorbidity, or individuals being diagnosed with multiple conditions. Because of this, there was a desire to find ways to redefine conditions to include more symptoms.
- Experts argued that the criteria for many conditions were so sensitive that people were being over-diagnosed… or so specific that no one was being diagnosed.
- It was felt that the Not Otherwise Specified (NOS) category was being used too much.
- It was difficult to provide laboratory markers or tests to back up medical opinions regarding conditions.
- The DSM was actually hurting the progress of research because it allowed conditions to be defined by psychiatrists who simply reported about which symptoms characterized which disorders rather than defining them based on brain measures and behaviors patterns.
- There was an over-emphasis in the previous diagnostic manual on mind-body dualism.
- Primary care physicians found the DSM-IV “imponderable.”
- The diagnostic manual itself was found to be pejorative by many.
- Diagnoses were not used appropriately by either psychiatrists or primary care physicians.
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As you can see, that’s a pretty long list with a number of truly strong problems. You can easily see why disability insurance policies covered under ERISA might not want to use a manual that could over-diagnose someone or call for expensive treatment that wasn’t clear or even potentially helpful.
Unfortunately, we won’t really know if the DSM-V is any better at fixing these issues for several years. In the meantime, if you’re filing a disability claim, you’ll want to make sure that you work with knowledgeable long term disability attorneys who are familiar with the latest medical definitions and requirements.
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