Psychiatry: "Be careful what you diagnose"
Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
More posts by Christiane Fux All content is checked by medical journalists.In May the new edition of the "Psychobibel" appears: the diagnostic manual of the powerful American psychiatry association. But the work is highly controversial. The psychiatrist Prof. Peter Falkai from the University of Munich reports in the interview about the opportunities and risks of the innovations.
Prof. Dr. Peter Falkai
Prof. Dr. Peter Falkai is Director of the Clinic for Psychiatry and Psychotherapy at the University of Munich Clinic.
Prof. Falkai *, the new DSM-5 Diagnostic Manual is being hotly debated. Will people suddenly receive a psychiatric diagnosis who were previously not considered sick?
That's right, that's the price we're paying. But it doesn't mean that these people didn't have any mental problems before. When someone comes to us as psychiatrists, the chances are high that they actually have serious complaints.
Of course you have to be critical with new diagnostic systems and use them responsibly. In psychiatry you have to be extra careful what you diagnose, because people are still stigmatized.
The book names true diagnostic monsters like the "Disruptive Mood Dysregulation Disorder", which affects extremely irritable children with severe outbursts of anger. Don't all parents with children in the defiant phase come and say: "My child is crazy?"
I can only shake my head with some of the new diagnoses. But I'm not a child and youth psychiatrist, so I don't know the background.
Burnout as a diagnosis, however, is not intended.
That's how it should be. Burnout is not a disease, but it is a risky state in which the risk of getting sick is increased. In fact, many people who come to the practice because of burnout already have real depression.
Is there even a clear line between healthy and sick?
There definitely are. We have clear criteria for when someone is sick in the sense of needing treatment. If certain symptoms affect a person in such a way that they or the environment suffer significantly from them, then one speaks of a disease. It's the same with mental illness.
One of the strongest critics of the DSM-5 is Allen Frances, one of the lead authors of the old book version. It has triggered a deluge of diagnoses such as ADHD and bipolar disorder in children. Now he fears that something similar is threatening.
There are of course points in DSM-5 that can be discussed. Of course, reading Mr Frances' in-depth commentary on ADHD makes you wonder what happened back then. And of course he is right: these diagnoses have been made more frequently since then, and children are treated more often with medication. We have to ask ourselves whether that is okay.
Is that it?
It can also be seen as a positive development when more people receive a certain diagnosis. Perhaps in the past you simply didn't look very closely or people didn't dare to seek help, so that some of the patients went undetected. ADHD is not a fad, it is a disease. Nevertheless, we have to be very careful that mental illnesses are not overdiagnosed.
That is the danger when the attention is focused heavily on a disease.
Yes, I'll say it very nastily: What I am busy with, I see it more often.
Why was the new edition necessary now?
The previous version is almost 20 years old. A lot has happened in research since then and we need to take the results into account. Take the borderline example. Twenty years ago, psychiatrists were quite at a loss about this. It has often been mistaken for undiscovered schizophrenia. The syndrome has now been well researched - and that means above all that patients can be better helped.
A major criticism is the liaison of many authors and experts with the pharmaceutical industry.
The allegation is that the manual is intended to create new patient groups in order to earn more money. I see it this way: Of course there are conflicts of interest that have to be uncovered and identified. But I really think it is an exaggeration to assume that diagnoses have only been adjusted in order to open up new sources of money or new markets.
What significance does the new manual have for Germany?
For us it is not relevant at first. We follow the ICD-10 diagnostic catalog, which is used to measure what the doctor can bill. ICD-10 is currently also being revised. And this revision is sure to be influenced by DSM-5 as well.
Prof. Falkai, thank you very much for the interview.
