From manual to bible: the questionable hegemony of DSM IV.

摘要

The DSM started out as a laudable idea: to increase the reliability of psychiatric diagnoses. However, through successive revisions, it has created increasing controversy and confusion. So much so, that there has been a proliferation of publications critical of it, even by leaders within American psychiatry [1-4]. DSM IV has now achieved iconic status - far beyond what had been originally intended [5]. Referred to as the 'bible' of psychiatrists (more so because of its omnipresence than out of respect) it is regarded as the definitive authority on psychiatric diagnosis. For instance, in the United States, it has become a central 'cog' in the healthcare system, one that helps determine payments to doctors and hospitals, medication 'approvals' [6-8] and (until federal parity legislation was recently introduced [9]) the scope of health insurance coverage. And despite DSM IV's own caveats, even the American legal system has conferred it inflated credibility in courtrooms across the country [10,11].