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Saturday, December 21, 2013

Ethical Considerations in the Development and Application of Mental and Behavioral Nosologies: Lessons from DSM-5

By Robert M. Gordon and Lisa Cosgrove
Psychological Injury and Law
December 13, 2013


We are not likely to find a diagnostic system as “unethical,” per se, but rather find that it creates ethical concerns in its formulation and application. There is an increased risk of misuse and misunderstanding of the DSM-5 particularly when applied to forensic assessment because of documented problems with reliability and validity. For example, when field tested, the American Psychiatric Association reported diagnostic category kappa levels as acceptable that were far below the standard level of acceptability. The DSM-5 does not offer sensitivity and specificity levels and thus psychologists must keep this in mind when using or teaching this manual. Also, especially in light of concerns about diagnostic inflation, we recommend that psychologists exercise caution when using the DSM-5 in forensic assessments, including civil and criminal cases. Alternatives to the DSM-5, such as the International Classification of Diseases and the Psychodynamic Diagnostic Manual are reviewed.

Here is an excerpt:

It should be emphasized that ethical concerns about DSM-5 panel members having commercial ties is not meant in any way to imply that any task force or work group member intentionally made pro- industry decisions. Decades of research have demonstrated that cognitive biases are commonplace and very difficult to eradicate, and more recent studies suggest that disclosure of financial conflicts of interest may actually worsen bias (Dana & Lowenstein, 2003). This is because bias is most often manifested in subtle ways unbeknownst to the researcher or clinician, and thus is usually implicit and unintentional. Physicians—like everyone else—have ethical blind spots. Social scientists have documented the fact that physicians often fail to recognize their vulnerability to commercial interests because they mistakenly believe that they are immune to marketing and industry influence (Sah & Faugh-Burman, 2013).

The entire article is here.
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