Sorry, you said insurance and I missed it somehow. I agree that laymen and insurance companies treat it as a bible, but I also think that’s how the APA presents it. If the goal is to compile “symptoms that tend to present together” the DSM does a poor job of making that clear.

I have several problems with the DSM. This isn’t an exhaustive list but off the top of my head:

-It’s based on the idea that there’s a clear line between “normal” and “disordered” mental functioning, and that we can quantify all of a person’s experiences to land on either side of that line. There are a handful of diagnoses that are discrete enough for me to say “you either have it or you don’t” but the majority of them are so arbitrary that they’re not useful. Mood disorders are especially vague.

-Inter-rater reliability is notoriously poor. I can diagnose anyone with a disorder to argue medical necessity for therapy.

-It includes conditions that cannot and should not be diagnosed by mental health professionals, like narcolepsy. It’s good for providers to know what narcolepsy is, but unless they’re going to include every other medical condition, I don’t know why they include the ones they do.

-DSM-5 broadened the criteria for several disorders, possibly to increase access to insurance coverage, but it’s edging ever closer to categorizing every human experience as a disorder. According to DSM-5, if you’re having depressive symptoms for more than 2 weeks after a loved one dies, it’s no longer grief and it’s considered a major depressive episode. When people criticized that bereavement clause, DSM-5-TR included “prolonged grief disorder” which extends the time you can grieve the loss without a MDD diagnosis. But grief is absolutely a normal response to loss, and sometimes it can be really disruptive and long-lasting. Why are we pretending that’s disordered?

-The majority of every DSM task force has been older white men, and we should be very skeptical of what they consider normal or not.