Undisclosed financial conflicts of interest in DSM-5 (2024) • Hacker News Board

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

#221

Post by dotancohen » Thu, Aug 28, 2025, 11:25 AM UTC

epgui wrote: post #211

dotancohen wrote: post #157

Earlier quoted context omitted.

If the DSM merely described sets of symptoms and gave them names, I'd buy that. But by also mentioning (e.g. suggesting) specific treatments, the book is used as a prescription tool, not just a diagnostic tool. > But if you’re going to judge the book, judge it by how it presents itself Quite so. I just as we judge people by their actions, not their words, I judge the DSM by how it's actual content is structured, not…

Oftentimes in psychiatry the treatments are just as important as anything else in establishing a diagnosis. There’s a well-known concept of “diagnosis by treatment” because unfortunately that’s often the best we can do in practice. It sounds backwards, and yeah, it is backwards, but oftentimes it’s the best we’ve got. At the same time you want treatments and clinical presentations to be somewhat coherent, and you don…

I'm not disagreeing with anything you say, although I did not know the concept of diagnosis by treatment is actually formerly recognised. That is exactly why the DSM is a prescription tool, not merely a diagnostic tool as reading of the introductory text would have one believe.

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

#222

Post by dns_snek » Thu, Aug 28, 2025, 3:05 PM UTC

moi2388 wrote: post #218

dns_snek wrote: post #206

Earlier quoted context omitted.

Those things make it flawed, not worthless. Your "precise" point was that the DSM-5 is worthless, please don't move the goalposts now.

Now you are moving the goalpost. I said that the DSM when not providing the underlying physical processes is worthless. I stand by that. In fact, historically whenever they did this they caused a lot of harm.

> Now you are moving the goalpost

I would beg to disagree: "The DSM is a bunch of nonsense. As long as [...], it’s worthless."

> DSM when not providing the underlying physical processes is worthless.

And when does the DSM ever provide the "underlying physical process"? It certainly doesn't for ADHD or any other chapters I happen to have read, which would make them worthless according to your criteria despite overwhelming evidence to the contrary.

And while I haven't read all 1000 pages of the DSM because it's not exactly my idea of a good time, I don't think it provides that kind of information in any chapter because we simply don't understand these disorders to that extent, as your original comment correctly observed.

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

#223

Post by dostick » Thu, Aug 28, 2025, 3:31 PM UTC

Easy to check by looking at records how DSM was worked on. Evidence of how financial conflicts translated into diagnostic expansion:

The Bereavement Exclusion Smoking Gun 100% of the DSM-IV mood disorders work group had financial ties to pharmaceutical companies Mad In America . This same group eliminated the bereavement exclusion in DSM-5, allowing normal grief to be diagnosed as major depression after just two weeks. Kenneth Kendler, speaking for the group, explicitly argued “Either the grief exclusion criterion needs to be eliminated or extended so that no depression that arises in the setting of adversity would be diagnosable” Mad In America - essentially arguing that context should be irrelevant to psychiatric diagnosis. This change was “perhaps the most controversial change from DSM-IV to DSM-5” PubMed Central and critics argued it would “result in an increasing number of persons with normal grief to be inappropriately diagnosed with MDD after only two weeks of depressive symptoms” American Academy of Family Physicians and lead to unnecessary antidepressant prescribing.

The ADHD Expansion: DSM-5 systematically lowered ADHD diagnostic thresholds: - Reduced symptom threshold from 6 to 5 symptoms for adults/adolescents over 17 PubMed Central Neurodivergent Insights - Increased age of onset requirement from 7 to 12 years old Neurodivergent Insights - Lowered impairment criteria - now only need to “reduce quality of functioning” rather than be “clinically significant” PubMed Central Critics specifically identified ADHD expansion as worsening the “false positive problem” by “expanding diagnosis to adults before addressing its reliability in children”

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

#224

Post by epgui » Thu, Aug 28, 2025, 10:06 PM UTC

dotancohen wrote: post #221

epgui wrote: post #211

Earlier quoted context omitted.

Oftentimes in psychiatry the treatments are just as important as anything else in establishing a diagnosis. There’s a well-known concept of “diagnosis by treatment” because unfortunately that’s often the best we can do in practice. It sounds backwards, and yeah, it is backwards, but oftentimes it’s the best we’ve got. At the same time you want treatments and clinical presentations to be somewhat coherent, and you don…

I'm not disagreeing with anything you say, although I did not know the concept of diagnosis by treatment is actually formerly recognised. That is exactly why the DSM is a prescription tool, not merely a diagnostic tool as reading of the introductory text would have one believe.

I don't know that it's formally recognized, but it's a thing.

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

#225

Post by tsoukase » Fri, Aug 29, 2025, 10:45 PM UTC

moi2388 wrote: post #219

tsoukase wrote: post #208

Earlier quoted context omitted.

You are wrong. Medicine does not need physical mechanisms for any diagnosis or therapy. It is preferable but not obligatory. A mere grouping of a symptom cluster forms a diagnosis as well as a therapeutic target.

Then I sure hope somebody with HIV never goes to the doctor with a runny nose, since I’m pretty sure staying in bed a week doesn’t solve the underlying issue.

In clinical medicine you follow correlations. A positive HIV test and a running nose mean red alarm. If you know that from sole past observations or by reading about immunosuppression plays no role in giving the indicative treatment. In research mechanisms are, of course, mandatory everywhere.