Connect
MJA
MJA

Cough disorder: an allegory on DSM-IV

Peter I Parry
Med J Aust 2009; 191 (11): . || doi: 10.5694/j.1326-5377.2009.tb03377.x
Published online: 7 December 2009

The DSM-IV is more a reliable descriptive nomenclature than a valid classification of diseases

The Diagnostic and statistical manual of mental disorders, third edition (DSM-III), published by the American Psychiatric Association in 1980, sought to define psychiatric syndromes in a way that increased the reliability of psychiatric terminology and diagnoses between practitioners and nations. The DSM-III’s introduction cautioned that, with regard to aetiology, it was a “generally atheoretical” document. The subsequent edition, the DSM-IV, published in 1994, went further, and cautioned specifically against diagnoses being applied in a “cookbook” fashion. Despite these warnings, conversion of the description of psychiatric disorders to discrete disease entities has not only occurred but, I believe, has also become problematic. Here, I present an allegory of a boy with “cough disorder” to illustrate.


  • 1 CAMHS (Child and Adolescent Mental Health Service), Southern Adelaide Health Service, Adelaide, SA.
  • 2 Department of Psychiatry, Flinders University, Adelaide, SA.



Competing interests:

None identified.

  • 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: American Psychiatric Association, 2000.
  • 2. Mukherjee S. Reducing American diagnosis of schizophrenia: will the DSM-III suffice? Br J Psychiatry 1983; 142: 414-418.
  • 3. McHugh PR, Slaveny PR. The perspectives of psychiatry. Baltimore: Johns Hopkins University Press, 1998.
  • 4. Parry P, Allison S. Pre-pubertal paediatric bipolar disorder: a controversy from America. Australas Psychiatry 2008; 16: 80-84.
  • 5. Hirschfeld R. Diagnosis and classification in psychiatry: Gerald Klerman’s contribution. Harv Rev Psychiatry 1994; 1: 306-309.
  • 6. Parker G. Beyond major depression. Psychol Med 2005; 35: 467-474.
  • 7. Boyce P. Restoring wisdom to the practice of psychiatry. Australas Psychiatry 2006; 14: 3-7.
  • 8. Smith R. Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Med 2005; 2: e138.
  • 9. Spielmans GI. The promotion of olanzapine in primary care: an examination of internal industry documents. Soc Sci Med 2009; 69: 14-20.
  • 10. Silove D. Biologism in psychiatry. Aust N Z J Psychiatry 1990; 24: 461-463.
  • 11. Lipowski ZJ. Psychiatry: mindless or brainless, both or neither? Can J Psychiatry 1989; 34: 249-254.
  • 12. Williams LL. Mental health and children. Los Angeles Times 2008; 14 Dec. http://articles.latimes.com/2008/12/14/editorial_pages/oe-williams14 (accessed Oct 2009).
  • 13. Double DB. What would Adolf Meyer have thought of the neo-Kraepelinian approach? Psychiatr Bull R Coll Psychiatr 1990; 14: 472-474.
  • 14. McHugh P, Romanoski A, Treisman G. Going from the bio-bio-bio model forward to bio-psycho-social reasoning. Course 45. American Psychiatric Association 162nd meeting course guide. American Psychiatric Association; 2009 May 16-21; San Francisco, Calif. http://pn.psychiatryonline.org/cgi/reprint/44/2/17.pdf (accessed Oct 2009, link no longer available).
  • 15. Andrews G, Goldberg DP, Krueger RF, et al. Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity? Psychol Med. In press.
  • 16. Frances A. A warning sign on the road to DSM-V: beware of its unintended consequences. Psychiatric Times 2009; 26 Jun. http://www.psychiatrictimes.com/display/article/10168/1425378# (accessed Oct 2009).

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.