Key Points
Rationale
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been the predominant diagnostic system for mental health issues worldwide for decades.
However, psychologists’ current attitudes toward the DSM-5, published in 2013, remained unclear. Previous research suggested that psychologists viewed the manual with suspicion and used it primarily to secure third-party payments (Miller et al., 1981; Smith & Kraft, 1983).
This study aimed to examine psychologist attitudes toward DSM-5 and several alternatives to it, including the International Classification of Diseases (ICD), Research Domain Criteria (RDoC), Psychodynamic Diagnostic Manual-2 (PDM), Operationalized Psychodynamic Diagnosis (OPD), Hierarchical Taxonomy of Psychopathology (HiTOP), and Power Threat Meaning Framework (PTMF).
The researchers sought to determine if psychologists’ attitudes have changed since DSM-5 appeared and to assess familiarity with and support for alternative diagnostic systems.
Understanding psychologists’ perspectives on diagnostic systems is crucial for informing future developments in the field and identifying potential gaps in knowledge or training.
Method
The study employed a 49-item online survey using Qualtrics. The survey contained various question types, including fill-in responses, forced choice, multiple response, and visual analogue scale (VAS) items.
Participants were asked about their use of DSM-5, attitudes toward it, familiarity with alternatives, and general views on diagnosis.
Sample
The final sample consisted of 703 participants who had completed a doctoral degree (PhD, PsyD, or EdD), were licensed psychologists, and had completed at least 75% of the non-demographic survey items. The sample included 538 clinical psychologists, 93 counseling psychologists, 25 school psychologists, and 45 who selected “other.”
Measures
The survey covered various aspects of DSM-5 use and attitudes, including frequency of use, reasons for use, perceived advantages and disadvantages, satisfaction with DSM-5, views on its impact, familiarity with alternatives, support for alternatives, and general attitudes about diagnosis and DSM.
Statistical measures
Analyses included one-sample t-tests to compare group means to the neutral point on 15-point scales, and comparisons across theoretical orientations (cognitive-behavioral therapy, psychodynamic, humanistic/constructivist/systems, and integrative/eclectic).
Due to the large number of tests, the significance level was set at α = .001.
Results
Insight
This study reveals that psychologists’ attitudes toward DSM-5 remain largely consistent with views expressed about earlier versions of the manual dating back to the 1980s.
Despite multiple revisions aimed at improving the DSM, psychologists continue to express mixed feelings about it, particularly those from psychodynamic and humanistic/constructivist/systems orientations.
The research highlights a paradox in the field: while psychologists are generally dissatisfied with DSM-5, they continue to use it widely, primarily for practical reasons such as insurance reimbursement.
The study also uncovered a strong interest in alternatives to DSM-5 among psychologists, but a lack of familiarity with most existing alternatives.
This gap between interest and knowledge points to a need for increased education and training on alternative diagnostic systems in psychology curricula and continuing education programs.
The varying attitudes across theoretical orientations suggest that a one-size-fits-all approach to diagnosis may not be ideal for the field of psychology.
Future research could explore the potential benefits of multiple diagnostic systems tailored to different theoretical approaches or clinical needs.
Strengths
Limitations
Clinical Implications
The findings have significant implications for clinical psychology practice and education:
References
Primary reference
Raskin, J. D., Maynard, D., & Gayle, M. C. (2022). Psychologist attitudes toward DSM-5 and its alternatives.Professional Psychology: Research and Practice,53(6), 553.https://doi.org/10.1037/pro0000480
Other references
American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.).https://doi.org/10.1176/appi.books.9780890425596
Smith, D., & Kraft, W. A. (1983). DSM-III: Do psychologists really want an alternative?American Psychologist, 38(7), 777–785.https://doi.org/10.1037/0003-066X.38.7.777
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
