Diagnostic Criteria

[Angrboda]

I'm going to comment without doing some necessary research in the matter, so consider these remarks tentative and provisional.

First, let's restore the original formatting of the Wikipedia entry, as your reformatting of the text seems to alter its meaning.

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7. Alterations in systems of meaning

• loss of sustaining faith
  
• sense of hopelessness and despair
  

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So, first off, it's not clear either that a) this is a conjunctive list, that all elements under seven are required, or that the two elements listed are examples of 7, and b) it doesn't specify religious faith in particular. People have sustaining faith in many things, from humanity, to their own competence, to the idea that things will ultimately turn out all right; loss of faith in these would parallel the second term, hopelessness and despair. So I don't think they're necessarily referring to a loss of faith in a particular religious doctrine, nor including absence of faith in the mix; however, there may be some justification for including a recent and exaggerated loss of religious faith. If someone has been a devout Catholic their whole life, and they suddenly become a hand-wringing nihilist, it may very well be symptomatic of a larger issue.

Second, it's worth noting that this is a proposed inclusion and is not currently a part of either the DSM or the ICD. And I'll note that, from personal experience, DSM diagnoses tend to follow a pattern of listing a number of symptoms and then noting that a certain number of those listed are required for diagnosis. Not all people with any particular syndrome will display all characteristics of the syndrome, and perhaps all this is saying is that alterations in systems of meaning are typical for a large class of patients suffering from this disorder.

Third, I'd have to track down the specific passage, but somewhere in the back of the DSM in the section on differential diagnosis it remarks that if some belief or trait is considered normal for that person's culture or religion, it is not to be included in the differential diagnosis. Since a lack of religious faith is normal for your culture [atheism] and your religious community, it would ordinarily be discarded in the diagnostic process.

Fourth, diagnoses are, imo, geared toward identifying people with common characteristics (syndromes) in order to guide treatment, not to diagnose etiology or specific malfunction. Symptoms consonant with depression are common in PTSD, standard, and it's not surprising that a trait which is commonly associated with depression would end up in the laundry list of traits associated with complex PTSD. Moreover, since the list is diagnostic, and doesn't indicate a causal relationship between the two (that alterations in meaning are a cause of complex PTSD), I'm not sure I understand what your difficulty is; I think the only real criteria here needs to be whether or not the symptom is strongly correlated with the presence of other symptoms in the disorder, and I think it's reasonable to suspect in this case that it is.

Anyway, my two cents worth, on first gander at the wiki page. I understand a major revision of the DSM is in the works, so there are likely to be a lot of controversial items related to potential changes and inclusions in the new DSM. (For example, it's historically been an r.o. [rule out] condition that a person not have suffered a major loss recently in diagnosing depression; removing that r.o. has caused considerable controversy by people who suggest that it "medicalizes ordinary grief.") I'd say wait until the dust clears on this and other potential inclusions.

(For another take, I've got a book on psychopathy which talks about the politicalized atmosphere surrounding the creation of the original DSM which many found shocking. And it would be an exaggeration to say that those days are entirely behind them, as creation and development of diagnostic categories is still a highly politicized and somewhat unscientific exercise. For another example, look at accounts of the deliberations over what to include in the case of PMS and PMDD.)

The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the validity and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from 'normality'; possible cultural bias; medicalization of human distress and financial conflicts of interest, including with the practice of psychiatrists and with the pharmaceutical industry; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement. The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically adding up to over $100 million.

Ben Goldacre has a book on big Pharma that I will be reading for a group in the upcoming months. I'm sure there will be interresting tidbits in there; I'll try to keep you in mind.