The American Psychiatric Association has just approved revisions to the manual used to diagnose the things that go bump in your soul. The first revision of Diagnostic and Statistical Manual of Mental Disorders (DSM) in 20 years dictates who gets treatment and how it is treated for the foreseeable future. There are some big changes in store for you and your shrink.
The DSM-V will be published in May and reflects a titanic effort on the part of American psychiatric community. The last version of the manual, DSM-IV, was published in 1994, and the process of revising the manual for the DSM-5 began all the way back in 2006.
The new manual has been subjected to enormous public scrutiny and supposedly reflects the latest and best of what we know about psychiatry. The changes affect the most commonly discussed disorders and conditions including revised classifications for Asperger’s syndrome, hoarding and substance abuse. Here’s a rundown of the biggest changes, selected from the APA’s press release (PDF):
Autism spectrum disorder: The criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified), into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism.
Binge eating disorder will be moved from DSM-IV’s Appendix B: Criteria Sets and Axes Provided for Further Study to DSM-5 Section 2. The change is intended to better represent the symptoms and behaviours of people with this condition.
Hoarding disorder is new to DSM-5. Its addition to DSM is supported by extensive scientific research on this disorder. This disorder will help characterise people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behaviour usually has harmful effects-emotional, physical, social, financial and even legal- for a hoarder and family members.
Pedophilic disorder criteria will remain unchanged from DSM-IV, but the disorder name will be revised from pedophilia to pedophilic disorder.
Posttraumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders. DSM-5 pays more attention to the behavioural symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. PTSD will also be more developmentally sensitive for children and adolescents.
Substance use disorder will combine the DSM-IV categories of substance abuse and substance dependence. In this one overarching disorder, the criteria have not only been combined, but strengthened. Previous substance abuse criteria required only one symptom while the DSM-5’s mild substance use disorder requires two to three symptoms.
APA President Dilip Jeste succinctly describe the difficulty of getting the manual just right:
Narrowing diagnostic criteria may be blamed for excluding some patients from insurance coverage and needed services, while expanded efforts to diagnose (and treat) patients in the early stages of illness to prevent its chronicity are sometimes criticised for increasing its prevalence and potentially expanding the market for the pharmaceutical industry
Obviously, the full impact of these changes won’t be known until the DSM-5 is published in May, but the APA’s decisions on both substance abuse and autism are interesting. Rather than classify the disorders ultra-specifically, they are both increasingly described as spectrums of behaviour, which gives doctors a lot more leeway when diagnosing and treating symptoms. [APA via WaPo]