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Volume 29 • Number 1

January 2015



Psychological Justice: DSM-5, False Positive Diagnosis, and Fair Equality of Opportunity

by Jerome C. Wakefield

The run-up to the publication of the fifth edition of the American Psychiat- ric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was marked by intensive controversy about both process and content. However, by far the most heatedly discussed issue was whether DSM-5's revisions accelerated a trend toward expanding psychiatric diagnosis beyond the bounds of genuine psychiatric disorder to encompass problems in living. The DSM-5 diagnostic criteria, it was claimed, pathologize normal psychological variation, potentially yielding "false positive" diagnoses—that is, diagnoses that mistakenly label normal conditions as mental disorders. For example, Allen frances, who had been Chair of the Task force on DSM-IV and was the most vocal critic of DSM-5, asserted:

DSM-5 will turn temper tantrums into a mental disorder. . . . Normal grief will become Major Depressive Disorder. . . . The everyday forgetting characteristic of old age will now be misdiagnosed . . . creating a huge false positive population of people. . . . Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM-5 has instead turned it into a psychiatric illness. . . . DSM-5 has created a slippery slope by introducing the concept of behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot. . . . Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and 'behavioral addictions' will soon be mislabeled as psychiatrically sick.

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ISSN: 2152-0542