92436 Diagnostic And Statistical Manual Of Mental Disorders Assessment 3 Answer

Answer :

Introduction

“Diagnostic and statistical manual of mental disorders” (DSM) is a handbook used by mental health professionals and clinicians to diagnose psychiatric illness (APA, 2012). It includes all the mental health disorder categories for both children and adults. With its success, DSM has also been under controversial debates due to some of the added diagnostic procedures and criteria's. This essay aims at highlighting controversial DSM diagnosis along with claims of its controversy. Further, it deals with the analysis of qualitative analysis of mental health consumers.  

Current controversial DSM diagnosis

According to Hornstein (2009), a personality disorder is among the topmost controversial diagnosis under DSM. A lot of people believe that personality disorders listed under DSM V are categories of Psychiatric disorders but many others believe that these are just fictions that have been over-highlighted by the media and mental therapists.  

Studies suggest that the potential triggers of personality disorder include environmental influences, childhood experiences (abuse or trauma) and genetics (Beck et al., 1990). Also, Calvo et al. (2020) state that the factors can contribute to the development of mental illness and behavioural and cognitive techniques can be an effective option for the treatment of such factors including a long term therapy. In contrast to this, personality disorders are always under controversy in terms of their terminology, classification, treatment options and diagnostic criteria (Tyrer et al., 2019). In support of this SMRL (2010) states that it is not clear that personality disorders exist as an objective disorder or not. The Work Group's key purpose to limit the number of particular personality disorders has been to minimise comorbidity (Pull, 2013). The DSM-5 will maintain 6 of the 10 distinct types of personality disorder described in DSM-IV - TR while excluding the other four categories.

Further, Kamens (2010) put forth that people simply believe that personality disorder does not exist. It is immoral to classify an individual based on his personality and diagnosing someone personality at fault simply means insulting the individual. In many cases, it can turn critical rather than useful for the person. In addition to this, personality disorder diagnosis is controversial because it is classified as the ideology of understating an individual's distress and termed as the medical model (Garb, 1994). Many researchers argue that it is just a way of examining and explaining one’s behaviour, thinking and feeling and not a disorder and are just included to align with the medical psychiatric system (Schwitzer 2015). Moreover, the DSM diagnostic criterion is only based on the medical model and is made to meet the roles, judgements and expectations which are normal within the culture. 

Butcher et al. (2009) state that there are no specific clinical or medical tests available for the diagnosis of personality disorder. The diagnosis cannot be performed based on the blood samples, genetic testing or brains scans. Only criteria to know personality disorders are the in-depth analysis of perspective, thoughts, behaviours, emotional feelings and cognition of a person. Ekselius et al. (2018) claim that these criteria are not objective or scientific to call a person mentally ill. 

Another reason for controversies against personality disorders is that they're mainly motivated by politics. One explanation was the 1983 update of the Mental Health Act, under which the government provided a legal definition with the words such as severe and dangerous Personality Disorder (DSPD) (Barber et al., 2016). This definition applies to a relatively small number of individuals that is a simple example of personality disorder as a condition positioned politically and socially, rather than an empirical clinical type of disease.

A high percentage of those diagnosed with a personality disorder have traumatic events during adolescence and abusive experiences during childhood. The definition of personality disorder often masks concerns on a broader extent such as child neglect and abuse, violence and other problems (Dunn et al., 2020). Rather than discussing these problems, placing labels on those who are troubled by them are viewed as harmful and is an unethical act on humanitarian grounds. In terms of this hypothesis, there are social policies, campaigns and proposed legislation that centres on people but very few that addresses these fundamental social challenges explicitly (Hornstein, 2009).

Consumers' qualitative experience with receiving/having a mental health diagnosis

The perspectives of providing mental health care to the patients are evident by nurses, professionals and psychiatrists. But when it comes to the important aspect of the mental health care and diagnosis that is "consumer" very fewer research centres on their perspectives and experiences. According to Ewart et al. (2016), consumers of mental health encountered many struggles, including the trivialization of patient concerns about their general wellbeing and physical health as it became clear that they had a mental disorder diagnosis. 

The mental health diagnosis experiences were mostly negative for the consumers in terms of judgements, unresponsiveness, scarcity of physical healthcare, disempowerment, undermined self-determination and some of the negative experiences were categorised as “nowhere to turn to” (Ewart et al., 2016).  Further, Perkins et al. (2018) state that the experiences of consumers having/receiving mental health diagnosis are both negative and positive. It will help service consumers understand their thoughts and feelings; provide a sense of relaxation, security and stabilisation; provide hope for recovering; strengthen customer relationships; and minimise complexity (Perkins et al., 2018). Diagnosis may also have negative effects, raising the societal burden on patients (Milton & Mullan, 2015). These effects include feelings of worthlessness, disempowerment, and dissatisfaction; discrimination and racism; symptoms intensified; and service detachment.

Qualitative analysis approaches reflect the views and perspectives of the consumers most accurately. Evidence shows that the diagnostic effect depends on multiple factors like the quality of service. The diagnosis was adversely perceived, for example, where consumer started feeling that psychologist had given insufficient information. Conversely, it may promote a sense of power, value, and confidence as patients were informed about their condition (Bromley et al., 2013). The perception is often influenced by the communication process (e.g., document vs face to face), the time is taken to determine and divulge a diagnosis, or if the diagnosis is presented as permanent or malevolent (Pitt et al., 2009). 

Users of the programme found it distressing when they sensed a lack of thorough and rigorous evaluation before diagnosis. Consumers indicated that diagnosis was more effective when it matched with their symptoms experience, providing comfort, support, and a context for understanding experiences (Peter & Jungbauer, 2019). Misdiagnosis may lead consumers to deny their diagnosis or to feel rejected. Where a diagnosis was considered to be incorrect, often due to a shift in symptomatology with time, service consumers indicated that withdrawing or shifting the diagnosis appropriately was helpful; diagnostic label permanence was considered ineffective. 

Mak and Wu (2006) state that some consumers admitted that even though the diagnosis was positive they do suffer self-stigmatization. Self-stigmatization is an internalisation of the common discourse conditioned regarding mental illness by derogatory perceptions and values. Self-stigma is also followed by feelings of inadequacy and desperation in the view of the individual's own willingness to make a change, which may in turn prevent recovery. 

Conclusion

From the above assessment, it can be concluded that personality disorder diagnosis is the most controversial diagnosis. This is due to many factors such as many people believe it is not a disorder, some believed it is not scientific, personality cannot be labelled as disorder and many factors are politically driven. Further, the essay explored quantitative consumer behaviour about the diagnosis. This indicates that experience can be both positive and negative.