That dilemma over what direction to take is nothing new to DSM. In trying to be too many things to too many people, DSM has ended up doing little of it well, claims Rutgers psychologist Nancy McWilliams, who’s involved in updating the Psychodynamic Diagnostic Manual (PDM), an alternative to DSM. “DSM doesn’t meet the needs of clinicians,” she states. McWilliams traces many of its current problems back to DSM-III, published in 1980. Trying to address the rise of different theoretical orientations, such as cognitive-behavioral therapy, self-psychology, and family systems, DSM-III “had to find syndromes and language which every therapist could buy into.” This led to a narrowing—many say denaturing—of the complexities of mental disorders, changing not only the way many therapists thought of clients and disorders, but forcing research into narrower channels.
Critics who’re encouraging therapists to find their insurance codes elsewhere and for free have also pointed to the hefty price tag of DSM-5—$199 for the complete book and $69 for the compact Desk Reference. In addition, there may be even more trouble ahead for DSM-5 since the new edition of PDM is due out in late 2014. PDM’s richer descriptions of disorders include such information as clients’ subjective experiences, treatment guidelines, and a dimensional perspective of disorders from mild to severe that makes diagnosis less of an either/or decision.
PDM hasn’t been on many therapists’ radar screens, partly because the first edition was self-published by a consortium of psychodynamic organizations and lacked a large promotional budget, and partly because many therapists believed they needed DSM for insurance coding. But the new PDM will be published by Guilford Press, a major publisher. As DSM-5’s critics keep hammering away at the new edition, therapists may find the new PDM to be a more clinically rich and useful tool.