The long awaited DSM-V was finally released for clinical use in May 2013, and was welcomed with a storm of debate. The task force charged with the revising the manual note that the manual had not been updated for 20 years and required revision to reflect changes in scientific knowledge and clinical experience in an ever shifting social context. Whether or not the DSM-V will alter clinical practice may depend on how the manual is viewed by practitioners.
One possible benefit of expanding the list of diagnoses in a psychiatric manual includes improving recognition of problematic behavior health issues by insurance companies who fund treatment for diagnosable problems. Expanding the diagnostic options may enhance access to beneficial services for many, and this could prove helpful to those who might not otherwise receive treatment. Practitioners in the US know all too well that a diagnosis is needed if the provider is going to be paid by an insurance company. It remains to be seen if the changes in the DSM-V affect payment to providers.
One point to consider in the reimbursement argument is that a diagnosis is not necessary for treatment because those in desperate need are not turned away, though ongoing therapy may be hard to find with or without a diagnosis. The downside of expanding the various diagnostic categories is that people may be less likely to be held accountable for behavior negative or even legal consequences, notably changes in the paraphilia categories. We must be vigilant that mental health does not become misused as an excuse for antisocial, illegal, or dangerous behaviors where it is inappropriate to do so.
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