The dry bible of the world of psychiatry – the Diagnostic and Statistical Manual of Mental Disorders, or DSM – has become a surprise bestseller amid growing popular interest in mental health.
Why is this important: A record shortage of mental health care providers, combined with an unprecedented demand for psychological support, has led to an increase in self-diagnosis, doctors say.
- With so many sources of emotional stress — the pandemic, gun violence, urban crime, the war in Ukraine — everyone wants to know if their own difficult feelings could be signs of something bigger.
- The number of people with symptoms of anxiety and depression has tripled during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.
Driving the news: The American Psychiatric Association (APA) released a new, revised edition of its standards manual, known as the DSM-5-TR, in March, the first update in nearly a decade.
“The public is dying to know more about mental illness, and this book just came out,” Saul Levin, CEO and Medical Director of APA, told Axios.
- “I think what’s really captured the imagination is that we’re sitting at home now and looking to say, ‘Boy, I’m feeling depressed – now let me go find out more about this. “,” adds Levin.
Yes, but: Doctors warn that laypersons should not use the book to diagnose themselves.
- The book’s rapid sales may reflect “a frantic attempt to get help somewhere, but it won’t help people,” says Robert Smith, an internist and professor of psychiatry at Michigan State University.
- “The DSM criteria, they’re not easy to understand,” Smith says. “In fact, primary care physicians don’t use them because they’re hard to understand.”
- Even within professional circles, the book sparks great controversy on topics such as which syndromes deserve recognition and how symptoms should be defined.
- For example, the latest version identifies “prolonged grief disorder” as a new diagnosis – but not everyone agrees.
The big picture: Mental health therapy has become mainstream. Young workers are demanding it as a social benefit, and athletes like Simone Biles, Naomi Osaka and Michael Phelps have openly described their struggles, urging others to seek help.
But with this attention comes the controversy:
- The issues addressed in the DSM — like the care of transgender children — have been at the center of society’s culture wars.
- While the gun legislation in the Senate includes funds for improved mental and behavioral health services — which most Americans welcome — the APA notes that “the overwhelming majority of people with mental are not violent”.
- Some young people crave the “curious stamp” of a DSM-5 diagnosis and become disappointed when they can’t get a label, Ralph Lewis, a Toronto psychiatrist, tells Axios.
Among Millennials and Generation Z, “There seems to be almost clamoring, the search for a psychiatric diagnosis and self-diagnosis – and a bit of competition among their peers to acquire those diagnoses,” Lewis said.
- There is a growing tendency to over-diagnose and “medicalize” normal anxieties and mundane neuroses, he writes in Psychology Today.
Between the lines: Health professionals in all fields are increasingly interested in psychiatry and the DSM as more and more patients show signs of mental disorders, psychiatrists say.
- “I had surgeon friends, internists, who all of a sudden said to me, ‘So I bought the book,'” Levin told Axios.
- “I hope this is an inflection point, that the country has now realized that we have to do things differently” and make mental health a priority, he says.