SUPPORTING EVIDENCE: DSM Misuse, Misdiagnosis, and Emotional Harm in Adult ADHD

Roxx Farron
Jul 7
3 min read

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I. Clinical Citations & Scholarly Sources

1. DSM-5 Adult ADHD Criteria Based on Pediatric Model

• The DSM-5 allows diagnosis of ADHD in adults by requiring only five of the nine pediatric symptoms to be met.

• No adult-specific symptom list was created despite known differences in presentation.

• Source: American Psychiatric Association, DSM-5 (2013)

2. Emotional Dysregulation as Core ADHD Symptom in Adults

• “Adults with ADHD often suffer from emotional dysregulation, including extreme emotional sensitivity, frustration intolerance, and rapid mood shifts.”

• Source: Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment.

3. Research Showing ADHD Emotional Collapse is Common, Not Comorbid

• Emotional symptoms like RSD are not secondary — they are central to the adult ADHD experience.

• Source: Asherson et al., The World Journal of Biological Psychiatry (2014); Biederman et al., Am J Psychiatry (2006)

4. DSM’s Use Despite APA Disclaimer

• The APA claims the DSM is not intended for individual diagnosis.

• However, it is regularly used by courts, insurance companies, and clinicians to determine treatment, benefits, and legal outcomes.

• Source: Journal of Ethics in Psychiatry and Psychology, 2017

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II. Provider Practice Failures

5. ADHD Diagnosed by Non-Specialists Using Only DSM Checklists

• Primary care physicians often diagnose ADHD using 15-minute checklist evaluations without collateral information.

• Only 20–35% of clinicians conduct developmental history reviews.

• Source: File: doctorsonlyDSM.docx (User submission)

6. No Specialized Training Required to Use DSM

• APA has not issued requirements for licensure, training, or clinical experience to use DSM criteria in practice.

• Source: File: The APA has not established formal guidelines.docx (User submission)

7. Mislabeling Due to Exclusion of Emotional Collapse

• Patients with internalized symptoms or emotional shutdown are often mislabeled as bipolar, borderline, or non-compliant.

• This is a result of DSM’s failure to account for relational trauma and emotion-based collapse.

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III. Real-World Impact and Pattern of Harm

8. Denial of Treatment or Disability

• Individuals with undiagnosed emotional symptoms are denied access to stimulant medication, therapy, or benefits due to appearing “non-classic.”

• Veterans, women, and trauma survivors are disproportionately affected.

9. Institutional Gaslighting

• When patients describe RSD or EOD, they are told these symptoms are not “real” or don’t match DSM models, leading to chronic invalidation and mismanagement.

10. System-Wide Silence and Deflection

• RSD was never included in the DSM and was dismissed from active research.

• Emotional dysregulation continues to be called “non-core,” despite mounting evidence.

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Compiled as supporting documentation for Theresa Alfonzo’s formal complaint and class action summary regarding DSM misuse and institutional failure to address adult ADHD and emotional collapse disorders.

1. DSM-5 – ADHD Criteria (APA, 2013)

• 📌 Adult ADHD criteria are based on pediatric symptom lists

• 🧠 Threshold reduced from 6 to 5 symptoms, but no adult-specific criteria were added.

🔗 https://www.psychiatry.org/psychiatrists/practice/dsm

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2. Barkley, R. A. (2015)

• 📌 Emotional dysregulation is a core feature of adult ADHD

• Calls it “deficient emotional self-regulation” — not secondary, but central.

🔗 https://doi.org/10.4324/9781315661814

(Book: ADHD: A Handbook for Diagnosis and Treatment)

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3. Asherson et al. – World J Biol Psychiatry (2014)