I was struck by something my registrar said the other day. We were discussing classification and relating some of the foolish categories in DSM to a particular patient’s situation she said: “there’s a diagnosis for that”. She was a bit puzzled when I laughed 
– not being aware of the Apple/iPhone/app store thing: “there’s an app for that”. I thought it was very appropriate though; there really is “a diagnosis for that” – almost whatever “that” might be.
Allow me to illustrate.
There were about 100 (106 iirc) diagnostic categories listed in the first iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. In the current DSM IV there are 295 (or 296, but who’s counting?). So we’re three times as mentally ill – or at least mentally ill in three times as many ways as we were in the 1950s.
Apparently.
I guess that makes for a lot of billable hours in countries based on private health-care.
As I hope is clear from my previous posts related to diagnostic classification, I am in no way belittling the experience and distress of people with any of these diagnoses – whether they represent actual illness or normal/understandable/expectable distress. I also know that we need a unifying system of classification, so that we don’t all go off on our own merrily idiosyncratic diagnostic journeys.
However…
The DSM is just drifting further and further from reality, logic, and medicine. There truly is “a diagnosis for that” – and billable diagnoses at that. People get seen as sick, they see themselves as sick, they get stuck in a victim role in the health system, they or the State spend lots of money pursuing treatments for things that aren’t actually illness states…
… And we shrinks can pat ourselves on the backs and feel important and needed because 1 in 2 people will need us at some point in their life* and one of “our” disorders is set to be the major source of disability worldwide.
I think it’s absolutely ridiculous, and it needs to stop. There’s some wonderful stuff being done lately (I’ll grab a link later) about delineating melancholia from just depression. There really seems to be a biological disturbance – you know: a “real” illness in melancholia, distinguishable from non-melancholic depression. Further work on things like that, to refine our categories based on medical science and biology, is what is needed – not just adding categories like temper dysregulation with dysphoria because you want to reduce the number of diagnoses of bipolar disorder in children….
*seriously, the recent Australian National Mental Health Survey reported a lifetime prevalence of 47% for major depression – which is patently ridiculous, and demonstrates clearly that the category as it stands does not delineate illness from distress.
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Perhaps the most damaging aspect of the DSM approach is that their categories are to be independent of any theory about their origin (except of course for PTSD where exposure to a specific type of event is one of the diagnostic criteria, only to be ignored by most diagnosticians who can find the same symptom cluster in other people).
Even when there is an effort made to try and explain why, there is a conflation between cause and reason. If I am angry and murderous and pick up a gun and shoot another person that is the reason he is shot. The cause of the hole in his shoulder is the bullet fired from the gun. All too often in psychiatry events which may be reasons for someone's distress, are identified as the cause. In the absence of any interest in causative factors, and a preoccupation with the multitude of reasons for a multitude of symptoms states, it is only logical to expect a multitude of disorders.
Most "sufferers" can manage to resolve the reason well enough and in most non illness settings the symptoms resolve. If a professional is busy sticking her/his nose into the person's life there is a reasonable chance that such nosey parkering will be credited with the recovery. And those who don't recover (because the cause remains unknown and ignored) get labelled personality disordered.