James Morrison’s chapter on Mood Disorders in DSM-5 Made Easy: The Clinician’s Guide to Diagnosis, gives insight into the complexity and still relative lack of uncertainty when it comes to diagnosing mood disorders. While reading the first two/thirds of this section on the DSM-5, which supposedly makes it easy to understand, one comment continuously entered my mind: “Confusing!” If this is an “easy” explanation of the DSM-5, I would hate to try to interpret the original source.
Many of the diagnoses mentioned in this section have an optional “other” category known as “unspecified.” This essentially allows a clinician to make a diagnosis for some type of mood disorder that is evident in a patient but does not meet the very specific criteria for a pre-determined diagnosis. I see both a benefit and a drawback to the incredibly specific diagnosis criteria: the benefit being that it limits/restricts diagnosticians from making a possibly significant and/or life-altering diagnosis without substantial evidence; the limit to the highly specific criteria for making a diagnosis when it comes to things like mood disorders is that these experiences can be highly subjective and even abstract or vague. So, these diagnosis criterions prevent unnecessary and possibly detrimental diagnoses from being made but also essentially attempt to create very concrete, objective, and empirical requirements for a medical condition that is highly subjective.
Morrison includes some language, specifically on pages 119 and 122 that seems demeaning to the patients he describes with words like “outrageous” and the observation “they are so distractible.” I’m sure (or at least hope) that Morrison’s intention in writing this guide was to make the world of mental health more accessible, but by including such language in his work, he only contributes to the harsh, negative stigma the world of mental health cannot seem to shake.
Morrison also reminds the reader that each edition of the DSM includes significant changes to its previous edition. Morrison highlights this point on page 143 under his description of cyclothymic disorder, stating “Note that this is a change from DSM-IV, which allowed a diagnosis of a bipolar disorder along with cyclothymic disorder.” Because the DSM changes fairly frequently and those changes are significant, it is apparent that mental health is still quite the enigma, even to experts in the field.