Chris Aiken, MD. Editor-in-Chief, The Carlat Psychiatry Report. Dr. Aiken has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
In 1974, Drs. Donald Goodwin and Samuel Guze put forth a radical idea. They wanted to pare down the unwieldy list of psychiatric diagnoses to only the most valid:
Panic disorder and specific phobias
Anorexia and bulimia
Somatization and conversion disorder
Antisocial personality disorder
Borderline personality disorder (provisional)
Alcohol & substance use disorders
Dementia and delirium
That list was published in their 1974 classic Psychiatric Diagnosis. The book is now in its seventh edition, but five decades of research have only elevated two diagnoses to the list: PTSD and borderline personality disorder (reluctant additions, as the editors believed their features overlapped too much with those of other disorders).
The editors of the DSM-III were inspired by this stoicism, but by the time of its release in 1980, the book had grown to include 265 disorders. The DSM editors got around this by adding a warning to many diagnoses, advising that we should not diagnose them if they are better explained by a more strongly validated disorder like one on Goodwin and Guze’s list. This warning is easy to miss, but it’s one of the most important parts of the book. Without it, the DSM is just a symptom checklist—one that inevitably leads to the kind of diagnostic creep Dr. Joel Paris warns about in this issue.