DSM-5, psychiatric epidemiology and the false positives problem

Research output: Contribution to journalReview articlepeer-review


The revision effort leading to the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was flawed in process, goals and outcome. The revision process suffered from lack of an adequate public record of the rationale for changes, thus shortchanging future scholarship. The goals, such as dimensionalising diagnosis, incorporating biomarkers and separating impairment from diagnosis, were ill-considered and mostly abandoned. However, DSM-5's greatest problem, and the target of the most vigorous and sustained criticism, was its failure to take seriously the false positives problem. By expanding diagnosis beyond plausible boundaries in ways inconsistent with DSM-5's own definition of disorder, DSM-5 threatened the validity of psychiatric research, including especially psychiatric epidemiology. I present four examples: increasing the symptom options while decreasing the diagnostic threshold for substance use disorder, elimination of the bereavement exclusion from major depression, allowing verbal arguments as evidence of intermittent explosive disorder and expanding attention-deficit/hyperactivity disorder to adults before addressing its manifest false positives problems.

Original languageEnglish (US)
Pages (from-to)188-196
Number of pages9
JournalEpidemiology and Psychiatric Sciences
Issue number3
StatePublished - Jun 13 2015


  • Attention-deficit hyperactivity disorder
  • DSM 5
  • bereavement exclusion
  • depression
  • diagnosis and classification
  • harmful dysfunction
  • intermittent explosive disorder
  • major depression
  • mental disorder
  • psychiatric diagnosis
  • substance use disorder

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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