Undisclosed financial conflicts of interest in DSM-5 (2024)

Original Article ↗ Hacker News Discussion ↗

Organizational Confusion (Psychiatric vs Psychological APA)

  • Several comments note confusion between the American Psychiatric Association (DSM-5 publisher) and the American Psychological Association, plus other “APA”s.
  • Some argue that, despite being distinct bodies, both professions tend to protect member interests, but only the psychiatric APA controls DSM.

Prevalence and Meaning of “Mental Illness”

  • Debate over statistics claiming ~50% of people meet criteria for a mental disorder at some point in life.
  • One side: if “most people are mentally ill,” definitions or thresholds may be wrong.
  • Others: many diagnoses are transient, like physical illnesses; high lifetime prevalence isn’t inherently absurd and can normalize seeking help.

Incentives, Pharma Influence, and Diagnostic Expansion

  • Many see DSM as vulnerable to misaligned incentives because diagnoses are subjective and treatments profitable.
  • Specific DSM-5 changes cited as suspect:
    • Removal of the bereavement exclusion, enabling earlier diagnosis of major depression after loss.
    • Lowered thresholds and broadened criteria for ADHD (fewer symptoms, later age of onset, weaker impairment standard).
  • Discussion of payment data: most conflicts were small (meals, travel), but some higher “services” payments are viewed as more troubling.

Validity and Purpose of the DSM

  • One camp: DSM is largely “billing codes” and an ontology for shared language, not a biology textbook; useful despite imperfections.
  • Critics: without clear mechanisms, references, and reproducible foundations, it’s pseudoscientific and overly norm-enforcing. Some go as far as saying psychology isn’t a true science.

Quality of Psychological Science

  • Commenters describe rampant p‑hacking, fraud cases, poor reproducibility, and narrow subject pools.
  • Past pathologizing of homosexuality and current treatment of trans issues are used as examples of politicized, culture-bound “disorders.”

Definition of Disorder and Social Norms

  • Ongoing argument over whether disorders are just deviations from social norms vs empirically harmful conditions.
  • Some stress that many conditions severely impair self-defined goals even in a supportive society, so labeling and treatment are justified.

Patient Experience and Treatment Value

  • Multiple firsthand accounts (e.g., ADHD) describe life-changing benefits from diagnosis and medication, even when life was not “catastrophically” impaired.
  • Others emphasize overprescription, marketing myths (e.g., “chemical imbalance”), and the risk of turning personality and life stress into pathology.

Methodological, Style, and Process Critiques

  • One reader finds DSM-5-TR internally vague, numerically unsupported, and surprisingly devoid of references.
  • Concern that experts with industry ties both define diagnoses and profit from treatments, unlike, say, crutch-makers who don’t define “broken leg.”
  • Some note forced or coerced psychiatric treatment still exists, complicating the idea that diagnoses are always voluntary tools.