![]() ![]() In most situations the clinical diagnosis of a DSM-5 mental disorder such as intellectual disability (intellectual developmental disorder), schizophrenia, major neurocognitive disorder, gambling disorder, or pedophilic disorder does not imply that an individual with such a condition meets legal criteria for the presence of a mental disorder or a specified legal standard (e.g., for competence, criminal responsibility, or disability). The APA now cautions that “use of the DSM-5 should be informed by an awareness of the risks and limitations of its use in forensic settings.” It contains a helpful statement for prosecutors: The new manual contains a prominently placed one-page “Cautionary Statement for Forensic Use of DSM-5.”10 This warning acknowledges that the DSM-5 will be used by courts and attorneys in “assessing the forensic consequences of mental disorders” even though it was not developed to meet the technical needs of the courts and legal professionals. ![]() Only time and input from testifying psychiatrists and psychologists will ultimately reveal how the changes will impact criminal cases meanwhile, this article discusses some issues for prosecutors to be aware of regarding the new manual. It will take time for the changes in the DSM-5 to be absorbed and applied in the mental health arena, and more time for the impact to spill over into courtrooms and caselaw. There is a substantial volume of commentary available on abuses and misuses in applying the Diagnostic and Statistical Manual in the criminal context, by both lawyers and mental health clinicians.9 ![]() The APA’s expansion of disorders and lowered thresholds for diagnoses may result in an increase in the prevalence of mental health issues raised in criminal cases.Īside from controversy within the mental health industry over this manual, there has always been a disconnect between the manual’s primary purpose-diagnosis in the mental health setting-and its use in the courtroom. Mental health issues also are often relevant to punishment evidence, a defendant’s mitigation case, and expert testimony. Mental health issues arise frequently in criminal cases, including when prosecutors must consider a defendant’s competency, sanity, eligibility for a death sentence, and intent. The APA task force developed this version’s content primarily in closed-door committees and required participants to sign non-disclosure agreements.4 A higher percentage of committee members than in previous revisions-about 70 percent-had ties to the pharmaceutical industry.5 In addition, the APA rejected proposals by other mental health professional associations for independent review of the revisions.6Ĭriticism of the development process has been followed by some vehement attacks on the content of the final, published DSM-5.7 An overriding issue in the new manual is its expansion of disorders and reduced thresholds for diagnoses, primarily in the mild psychiatric disorders.8 It replaces the DSM-IV, published in 1994, and the DSM-IV-TR (Text Revision), published in 2000.3Īlthough previous versions of the manual were widely accepted, the DSM-5 has been the target of considerable criticism and controversy. Assistant Criminal District Attorney in Dallas County Some issues important to prosecution and criminal cases about what changed in this manualĪfter a 14-year revision process, the American Psychiatric Association (APA) published the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders last May.1 The APA manuals are commonly considered the authoritative source in the mental health community on the criteria for diagnosing and classifying mental disorders.2 The latest manual, titled the “DSM-5” (they dropped the Roman numerals), is 947 pages and contains over 300 diagnoses. ![]()
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