The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is set to arrive in March. If you aren’t alarmed, you should be.

The DSM is the book from which all our mental health diagnoses come. It’s been with us since 1952 when it had a little over a hundred diagnoses and was virtually unknown. It now offers over five hundred diagnoses that clinicians give out so frequently that 46 percent of American adults and 20 percent of American children and adolescents will receive one in their lifetimes.

The new edition (DSM-5-TR) isn’t getting much press, mainly because the American Psychiatric Association (APA), the private organization that publishes and profits from it, isn’t publicizing it. Why? The previous edition (the DSM-5) sparked a veritable uproar. Criticisms ranged from the authors’ ties to Big Pharma to the way the DSM pathologized normal thoughts, behaviors, and emotions and invented new diagnoses to how criteria were loosened to make disorders easier to diagnose to the fact that political wrangling, not science dictates what is deemed a mental illness.

The foundational problem with DSM diagnoses is that they’re scientifically invalid and largely unreliable and have been called “scientifically meaningless.” None can be objectively proven by a test, x-ray, or other biological marker and they aren’t discrete disease entities. (The only exceptions are dementia and rare chromosomal disorders.) They don’t exist outside a patient’s self-reported symptoms and the clinician diagnosing them. They don’t meet a standard of reliability, i.e., the chances of two clinicians agreeing on the same diagnosis in the same patient are somewhere between a coin toss and zilch.

The DSM-5-TR (TR for text revision) could have been a heroic act. The architects of the DSM could have spent the past decade removing or at the very least reevaluating the DSM’s many, many invalid, unreliable, and suspect diagnoses.

Instead, a new diagnosis was added (prolonged grief disorder, which essentially says that if you grieve for a loved one longer than one year and your grief makes life difficult, you have a mental illness) and the potential addition of suicidal ideation and self-harm as mental disorders. The other diagnoses remain intact.

 

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