Science, Rhetoric, and the DSM: A Comparative Text Review and Conceptual Critique of Changes to the DSM-5-TR Prefatory Material.

Rhetoric has long played an important role in legitimizing the "Bible" of American psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM), particularly since its third edition. Critics have consistently alleged that the confident scientific rhetoric of DSM's authors and advocates has often outpaced the science. In a welcome change of tone, the authors of the text's fifth edition (DSM-5) provided a more honest and sober acknowledgment of the limitations of DSM in the document's prefatory material. In the Introduction and Use of the Manual sections, the authors explicitly drew the reader's attention to a host of conceptual and empirical challenges faced by the DSM classification system. Many of these statements have been removed from the DSM-5-Text Revision (2022) prefatory material. The most notable are the removal of explicit statements concerning validity (and its definition), the concerns about reification, problems with comorbidity, and conceptual and empirical issues with a categorical approach to psychiatric diagnosis. We argue these textual omissions serve the rhetorical function of implying that, in the years since DSM-5, the science has caught up to the system and validated the major DSM diagnoses. This is, unfortunately, not the case, and an increasing chorus of critics agrees that the DSM system has a serious validity problem. While recognizing laudable changes, including the expanded coverage of sociocultural variables, systemic inequities, and gender diversity, we raise concerns about the rhetoric of the DSM-5-TR prefatory material. We contend that the textual changes may contribute to readers overestimating the empirical status of DSM disorders and underestimating the classification system's many limitations. Future editions should restore and expand upon DSM-5's more candid discussion of diagnostic limitations. [ABSTRACT FROM AUTHOR]