Article

View on DSM from Taiwan: transition from IV to 5

Authors:
  • College of Medicine, China Medical University, TAIWAN
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Abstract

The fifth edition of Diagnostic and Statistical Manual ofMental Disorders (DSM-5) had been officially launched inMay of 2013. Some are concerned about DSM-5’s ‘therelentless production of disorders and pathologizing of normalextremes’ (1) and hindering biological psychiatry progress (2),and others argue that DSM-5 problematically reduces diagnos-tic specificity and turns hyperinflation of current psychiatricdisorders (3, 4). However, the excessive discussion andattention for the launch of this new edition reflex an exaggera-tion of the function of this diagnostic system as the ‘doctrine’rather than the ‘dictionary’ in psychiatric clinical practices.Diagnostic and Statistical Manual of Mental Disorders hadoriginally been designed for research purposes, help cliniciansdifferentiate disorders with specific inclusion and exclusioncriteria, and help facilitate communication among psychiatricprofessionals. Traditional psychiatric training focuses onempathetic understanding into individual mental status,defining deviance and dysfunction, identifying distress anddangers, and then coding and classifying the psychopathologyinto diagnostic systems of DSM or International Classificationof Disorders (ICD). The overemphasis of DSM or ICD as agold standard will impair not only neuroscience progress butalso the essence of psychiatry.Although psychiatrists in Taiwan are trained with DSMcoding for academic and research and with ICD for nationalinsurance reimbursement, the major training for diagnosis isbased on psychopathology. Most trainees failed boardexamination due to weakness in clarifying psychopathology.We carried out a survey from January to June of 2007 byinquiring the opinions of all members of Taiwanese Society ofPsychiatry, including board certified psychiatrists (86.7%) andresident doctors (13.3%) on the DSM system. The question-naires were distributed by mail in January of 2007 and wereresent by email 3 months later to get additional response fromthose not responding to prior mails. A total of 233psychiatrists responded to the survey, where 2.7% respondthrough email and 95.3% respond through mail. We were tofind that 50.4% of psychiatrists responded that the diagnosticclassification system only has its importance in establishing thecommunication among the psychiatric professionals. Only23.7% felt the DSM system could facilitate information orunderstanding on psychopathology. In addition, 66.7% ofpsychiatrists encountered difficulty when applying the DSMsystem in context of Taiwanese culture. Finally, about 73%psychiatrists look forward to an ideal diagnostic classificationsystem that will incorporate pathogenesis, prognosis andtreatment choices in the future.Nowadays, less attention is paid to psychopathology inpsychiatric training and even board examinations, while morefocus is directed to the ‘picking-up criteria’ provided by theDSM. Human minds and behaviors are complex and contextspecific. Without fundamental understanding and training ofpsychopathology, collected symptoms to match the DSMmight be unreliable. Applying such a coding system in differentcultures or societies, this bias could be even worse. Hence, it isvery important about the purpose and context when we makeuse of DSM-5 criteria and diagnoses for training and clinicalpractice.J. P.-C. Chang

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Ltd All rights reserved DOI: 10.1111/acps
Acta Psychiatr Scand 2014: 1 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd All rights reserved DOI: 10.1111/acps.12244