Robert Spitzer (psychiatrist) - Position On The DSM

Position On The DSM

Spitzer was chair of the task force of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) which was released in 1980. Spitzer was a major architect of the modern classification of mental disorders which involves classifying mental disorders in discrete categories with specified diagnostic criteria, but later criticized what he saw as errors and excesses in the Manual's later versions; however, Spitzer maintained his position that the DSM is still better than the alternatives.

Spitzer was briefly featured in the 2007 BBC TV series The Trap, in which he stated that the DSM, by operationalizing the definitions of mental disorders while paying little attention to the context in which the symptoms occur, may have medicalized the normal human experiences of a significant number of people.

Spitzer co-authored a position paper in 2003 with DSM-IV editor Michael First, stating that the "DSM is generally viewed as clinically useful." The position paper based this observation on data such as surveys from practicing professionals and feedback from medical students and residents. The authors added that primary care physicians find the DSM too complicated for their use. While agreeing that DSM is far from perfect, they reject the call for it to be abandoned. The authors emphasizes that given then-current limitations in understanding psychiatric disorders, a multitude of DSM codes/dignoses might indeed apply to some patients, but that it would be a "total speculation" to assign a single diagnosis to a patient. The authors also acknowledged that the criteria for certain disorders are known to be poor, but argue that this is one of the reasons why the Manual must undergo periodic revisions. Further, the authors rejected calls to adopt the ICD-9 because it lacks diagnostic criteria and would " psychiatry back 30 years", while the ICD-10, they argue, closely resembles the DSM-III-R classification.

Spitzer has criticized the revision process of the DSM-5 for lacking transparency. He has also criticized specific proposals, like the proposed introduction of the psychosis risk syndrome for people who have mild symptoms found in psychotic disorders.