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Rigler, 2016 New DSM-5 criteria for ADHD - Does it matter?

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Commentary: The controversial DSM 5 was published in 2013, and in the past three years, even mainstream media has reported a rise in the use of stimulants among adults. With the DSM 5 requiring even fewer symptoms to make a diagnosis, according to this study, a significant increase of 65% in diagnosis was found. 


This is concerning considering the link between stimulant use causing other psychiatric problems such as depression and bipolar disorder. 




Compr Psychiatry. 2016 Jul;68:56-9. doi: 10.1016/j.comppsych.2016.03.008. Epub 2016 Mar 30.

New DSM-5 criteria for ADHD - Does it matter?

Rigler T1, Manor I2, Kalansky A3, Shorer Z4, Noyman I5, Sadaka Y6.



Abstract: http://www.ncbi.nlm.nih.gov/pubmed/27234183?log$=activity






The new Diagnostic Statistical Manual (DSM) requires the presence of fewer symptoms to make a diagnosis of adult ADHD while the criteria for diagnosis in childhood are unchanged as compared to previous editions. This study examines the prevalence of adults meeting the revised DSM-5 symptoms cutoff as compared to the previous DSM-IV symptoms cutoff.



This study is part of a larger nationwide study that evaluated the use of, and the attitudes toward, ADHD medications by university students. 445 students from four major university faculties were surveyed and filled out questionnaires for our study.



The proportion of participants that met the minimum threshold of six out of nine current symptoms in either of the two DSM-IV symptom domains (inattentive presentation and hyperactive/impulsive presentation) for ADHD was 12.7% while the proportion that met the minimum threshold of five symptoms in either of the DSM-5 symptom domains was 21%.



Since the new DSM requires fewer current symptoms for a diagnosis of ADHD, a significant increase (65%) was observed in the number of participants meeting the new cutoff as compared to the old DSM-IV symptoms cutoff. This increase in the number of adults meeting symptoms cutoff may affect the rates of adults diagnosed with ADHD. Using the new criteria may identify more adults with ADHD and fewer diagnoses will be missed. However, meeting the new symptoms cutoff should be considered within the overall clinical context to prevent over-diagnosis.





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With each edition the DSM becomes more comprehensive and lowers the barrier to confirming a diagnosis for many conditions.  


This is fine for categorisation purposes but it has the effect of seeming to medicalise normal adverse experiences with the result that unnecessary drug treatment may be initiated.


The experiences and symptoms are still very real but the question is if they require medication.  


As an example, almost everyone will grieve at the death of a family member but in nearly all cases this does not need any medication. Needless to say, you are dysfunctional, it feels awful and it becomes very hard to cope but this will pass in time.  For a very tiny minority who experience extraordinary grief which doesn't resolve that causes them collapse then they might benefit from very short term medication.  


For the rest of us, we should push through it and ignore the siren calls of modern medicine which promises a pill for every ill.  I think we shouldn't seek to minimise every bad feeling through pharmaceuticals because the eventual price may be far higher than we realise.


Just my 2 pence worth.

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Your 2 pence is actually worth a million, Riffick. You are spot on with your description of grief. In fact, grief is one of the most controversial aspects of the DSM 5. 


This is an article by Dr. Allen Frances, ironically the chairman of the DSM 4 taskforce. The DSM 4 changed the grief timeline from one year to only two months. But when it went down to only two weeks with the DSM 5, his conscience evidently caught up to him: 





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