I believe that the statement that was made in the DSM that I quoted is accurate.
For decades now, the studies conducted by the APA have consistently shown that even the most trained clinicians in the most favorable and unrealistic circumstances are unreliable in making diagnoses. In 1993 in “The Myth of the Reliability of DSM,” professors Stuart Kirk and Herb Kutchins wrote:
Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliably by regular mental health clinicians. Nor is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version. There are important methodological problems that limit the generalisability of most reliability studies. Each reliability study is constrained by the training and supervision of the interviewers, their motivation and commitment to diagnostic accuracy, their prior skill, the homogeneity of the clinical setting in regard to patient mix and base rates, and the methodological rigor achieved by the investigator in ensuring that the raters make diagnoses "independently." Equally important, most reliability studies have been conducted in specialised research settings and may have little bearing on the actual use of DSM by clinicians in normal, uncontrolled clinical settings, where external bureaucratic demands, reimbursement probabilities and potential stigma influence their judgements (Kirk and Kutchins, 1988; Kutchins and Kirk, 1988).
https://www.academyanalyticarts.org/kirk-myth-reliability-dsm
In a 2007 paper, psychiatry professor Ahmed Aboraya reviewed some of the evidence of reliable with use of DSM-IV (my bolding):
The DSM-III was also intended to improve the reliability of psychiatric diagnoses, an everlasting problem in psychiatry.[4–13]
Today, 26 years later, did the DSM system succeed in improving the reliability of psychiatric diagnoses? Two answers exist. The DSM did improve the reliability of psychiatric diagnoses at the research level. If a researcher or a clinician can afford to spend 2 to 3 hours per patient using the DSM criteria and a structured interview or a rating scale, the reliability would improve.[13] For psychiatrists and clinicians, who live in a world without hours to spare, the reliability of psychiatric diagnoses is still poor.[2,3] Even Spitzer and Frances, the directors of DSM-III and DSM-IV Task Force, admit that the desired reliability among the practicing clinicians has not been obtained.[3] To illustrate the problem of unreliablity, I reviewed the charts of a 64-year-old African American man who had more than 38 psychiatric admissions over a span of 43 years. Upon discharge the patient had the following diagnoses: schizophrenia, catatonia; schizophrenia, paranoid; schizophrenia, hebephrenic; schizophrenia, undifferentiated; schizoaffective disorder; bipolar type; and bipolar disorder with psychosis. Psychiatrists and clinicians attest that patients with multiple diagnoses are not uncommon.
The Reliability of Psychiatric Diagnoses: Point—Our psychiatric Diagnoses are Still Unreliable
In 2012, Dr. Frances (mentioned above) published an article in
Psychology Today:
DSM-5: How Reliable Is Reliable Enough?
This is the title of a disturbing commentary written by the leaders of the DSM 5 Task Force and published in this month's American Journal of Psychiatry. The contents suggest that we must lower our expectations and be satisfied with levels of unreliability in DSM 5 that historically have been clearly unacceptable. Two approaches are possible when the DSM 5 field trials reveal low reliability for a given suggestion: 1) admit that the suggestion was a bad idea or that it is written so ambiguously as to be unusable in clinical practice, research, and forensics; Or, 2) declare by arbitrary fiat that the low reliability is indeed now to be relabeled 'acceptable'.
In the past, 'acceptable' meant kappas of 0.6 or above. When the personality disorders in DSM III came in at 0.54, they were roundly derided and given only a reluctant bye. For DSM 5, 'acceptable' reliability has been reduced to a startling 0.2-0.4. This barely exceeds the level of agreement you might expect to get by pure chance.
DSM-5: How Reliable Is Reliable Enough?
Besides the diagnoses, the very creation of mental disorder designations is often motivated by political and financial considerations. Due largely to public pressure, in 1973 the diagnosis of “Homosexuality” was eliminated from the 6th printing of DSM-II, but was replaced with Sexual Orientation Disturbance, which designated homosexuality as a mental disorder if the person found his/her same-sex attractions distressing and wanted to change.
As has been noted by a number of scholars, creating this disorder allowed psychiatrists to continue to receive insurance reimbursements for “conversion therapy”. In DSM-III (1980), SOD was essentially renamed Ego Dystonic Homosexuality. This disorder was dropped
per se from DSM-III-R in 1987, but was specifically described as an example of Sexual Disorder Not Otherwise Specified.
One can easily discern parallels between the APA's handling of “homosexuality” and transgender identity. The Gender Identity Disorder diagnosis came into being in DSM-III, and ever since, transgender persons have pleaded that transgender identification is not a mental illness. The APA is nothing if not recalcitrant in assimilating such information. Eventually in DSM-5, GID was changed to Gender Dysphoria Disorder, with diagnostic criteria that place less emphasis on identity and more on the transgendered person's dissatisfaction with his/her biological sex and primary and secondary sex characteristics, and the desire to change to gender. However, given that mere cross-gender identification will generally entail some degree with dissatisfaction with one's biological gender, it's difficult not to see the DSM-5 as accomplishing nothing more than a change in nomenclature.
Because neither the diagnostic criteria nor the diagnosis of mental disorders entails any objective biological measurements, racism is a factor in the diagnoses of mental disorders.
Examining the records of 135,000 US veterans, Blow et al. found that, despite similar symptom presentations, African Americans were more than 4 times more likely than whites to be diagnosed with schizophrenia (instead of bipolar disorder), while Hispanic Americans were 3.15 times more likely to recieve a diagnosis of schizophrenia than whites. As the article notes, people diagnosed with a psychotic disorder are treated quite differently than those given a mood disorder (bipolar) diagnosis. People diagnosed with a psychotic disorder are prescribed more toxic, more debilitating drugs and are more often subjected to forced drugging and confinement.
If any other medical discipline or government-endorsed institution demonstrated such racism today, there would be public outrage. The institution would be shut down.
