Recently the DSM-5 Task Force of psychiatrists dropped two diagnoses from its new manual—“attenuated psychosis syndrome” (proposed to identify people at risk of developing psychosis), and “mixed anxiety depressive disorder” (a hybrid of two mood problems). This is welcome news to both mental health professionals and the people who utilize them.
Taking Asperger’s out of the manual, known as D.S.M.-V for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, does not mean the term will disappear. “We don’t want to say that no one can ever use this word,” Dr. Lord said, adding: “It’s not an evidence-based term. It may be something people would like to use to describe how they see themselves fitting into the spectrum.”
But the change, if approved by the manual’s editors and consultants, is likely to be controversial.
The debate is particularly intense because the manual is both a medical guidebook and a cultural institution. It helps doctors make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment.
The manual — known by its initials and edition number, DSM-V — often organizes symptoms under an evocative name. Labels like obsessive-compulsive disorder have connotations in the wider culture and for an individual’s self-perception.
At a teleconference news briefing today, the American Psychiatric Association (APA) announced the task force that will oversee the development of the fifth edition of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM is the handbook used by psychiatrists and other mental health professionals in the United States as well as other countries around the world to diagnose and classify mental disorders. The DSM-V Task Force consists of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates.
The DSM-V is currently in preparation and slated for 2013 publication. Each time a new edition appears, the media ask whichever psychiatrist is the lead editor why a new edition was necessary, and like clockwork, each editor replies that it was because the previous edition really wasn’t scientific (Caplan, 1995). And each time a new edition appears, it contains many more categories than does the previous one. For instance, DSM-III-R contained 297 categories, and DSM-IV contained 374 (Caplan, 1995).
Ironically there are also concerns about DSM-V raising some diagnostic thresholds. New York Times reporter Benedict Carey, says that proposed changes in the definition of autism would greatly reduce the number of people diagnosed and make it much more difficult for many of them get the services they need.
Analyzing data from a large 1993 study researchers Fred Volkmar, Brian Reichow, and James McPartland, (all from Yale) found that among the 372 highest functioning children and adults in the study only 45 percent would met the new criteria for autism spectrum diagnosis.
First likes a lot of what he sees in the new DSM-V. For example, he likes the new manual's emphasis on suicide prevention, and its effort not just to diagnose a disorder but to give a clearer idea of its severity.
On the other hand, First is disturbed by the proposed diagnosis of people as having risk syndromes for psychosis and dementia.
"Psychotic risk syndrome is the worst idea in the whole thing," First says.
Another basic problem with the DSM: it tries to reduce the vastly complex experiences of your mind to a single number.
At last week's conference, there were tantalizing hints that the DSM-V might fix some of these problems. Dr. Steven Hyman, provost of Harvard, a former psychiatry professor at its medical school and a former director of the National Institute of Mental Health, agitated at the meeting for a new DSM framework that would stop trying to divide mental problems into discrete all-or-nothing categories.
Fortunately, the new diagnosis will get rid of the confusing term “dependence” (physically needing a drug to function isn’t actually addiction) and the stigmatizing term “abuse.” Unfortunately, however, it will also tremendously elevate the number of people considered alcoholics. One Australian study suggested that using DSM-5 definitions will increase the number of people diagnosed with alcoholism by a stunning 60%.
For instance, while anxiety mixed with depression is actually quite commonly seen in the wild of clinical practices, there is no specific diagnosis for this mixed mood state. The DSM-5 sought to correct this problem — that clinicians are treating millions for a problem the DSM says doesn’t technically exist. But critics worried the new criteria were too lax and might result in over-diagnosis.
The same was true for attenuated psychosis syndrome. The proposed diagnosis was an effort to get children and young adults into treatment sooner for experiencing weird thoughts or hallucinations.