Psychologist Attitudes Toward DSM-5 and Its Alternatives

Public Significance Statement This study found that nearly 90% of psychologists use DSM despite dissatisfaction with it. Psychologists see DSM's main advantage as third-party insurance reimbursement. Though they wish to see alternatives developed, they are unfamiliar with and unsupportive of any besides the International Classification of Diseases (ICD). Psychologists want alternatives but have a practical need to get paid that DSM currently meets. A survey of psychologists' attitudes toward the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), and its alternatives was conducted. Almost 90% of psychologists reported regularly consulting DSM-5, despite dissatisfaction with it. However, opinions varied by theoretical orientation. Cognitive-behavioral psychologists held positive attitudes about DSM, whereas psychodynamic and humanistic/constructivist/systems psychologists were negatively inclined toward it. Integrative/eclectic psychologists were in between. Diagnostic codes and identifying pathology were seen as DSM-5's biggest advantages, and the medicalization of psychosocial problems and obscuring individual differences as its biggest disadvantages. Psychologists supported developing alternatives to DSM-5, but when asked about six alternatives-International Classification of Diseases (ICD), Research Domain Criteria (RDoC), Psychodynamic Diagnostic Manual-2 (PDM), Operationalized Psychodynamic Diagnosis (OPD), Hierarchical Taxonomy of Psychopathology (HiTOP), and Power Threat Meaning Framework (PTMF)-they were generally unfamiliar with them except for ICD. Although not wishing to abandon the medical model, psychologists (except for cognitive-behaviorists) said DSM-5 relies too much on medical semantics and questioned whether mental disorders should be considered a subset of medical disorders. Overall, psychologists use DSM for practical reasons (diagnostic categories and codes) more than scientific ones (validity and reliability). This finding affirms something remarkable: Despite ongoing attention to revising and improving DSM over the past four decades, psychologists remain lukewarm toward it and strongly interested in alternatives. However, until alternatives are better known and provide the necessary practical advantages, psychologists will likely continue to use DSM despite their mixed feelings about it.