For those who know not, it is a compendium of psychiatric conditions that are reviewed with every edition with tthe latest edition being DSM-5 TR published by the American Psychiatric Association (APA).
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Psychiatrist here. So most of the issues with the DSM stem from the core issue that we do not have enough understanding about how the brain really works. We are unable in many diagnoses to link the disorder with a clear biological process. This is also why many of our treatments involve trying multiple things to find out what works. The brain is very complex and due to stigma and other such issues neuroscience is in many ways behind other medical fields.
This lack of understanding has lead to psychiatric diagnoses being based on descriptions of symptoms rather than specific biological mechanisms. And this ambiguity has lead to our diagnoses being corrupted by campaign groups wanting things to be defined in specific ways to suit their agendas. Which has in turn made our diagnoses unreliable and constantly getting regrouped based on pressure or fads.
There are some diagnoses that we have a clearer understanding of such as schizophrenia and bipolar. But despite physicians being able to clearly identify both of these diagnoses, unfortunately the diagnoses get tossed into patient notes incorrectly.
For example, schizophrenia the biologic process has a very clear history and progression. However from reading of the DSM, a person with long term brain damage from methamphetamine use can have all the symptoms of schizophrenia and therefore be falsely diagnosed with schizophrenia. They meet the dsm criteria for schizophrenia but the biologic process is completely different. And the treatment/ expected disease course is very different.
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