The Diagnostic and Statistical Manual of Mental Disorders is an enormous reference book that doctors use to diagnose mental disorders. The new DSM-5 was approved last Saturday by the American Psychiatric Association (APA) and will be published in May 2013. The last edition was published in 1994, almost two decades ago.
In his announcement message, APA President Dilip Jeste, M.D. states that the update reflects “a wealth of new studies on epidemiology, neurobiology, psychopathy, and treatment of various mental illnesses.”
Details of the draft criteria, formerly available at the DSM5.org website have now been removed, along with almost 2,300 public comments. However, indications are that the DSM-5 will likely contain many of the most debated changes. Here are some revisions reported to be included:
- Hoarding and skin picking (excoriation) will be added as mental disorders and binge eating has been moved forward out of the appendix section.
- The ‘bereavement exclusion’ for a diagnosis of major depression will be removed. Before, patients who were depressed after the loss of a loved one were not diagnosed as clinically depressed until two months had elapsed, so in the future, they could be diagnosed sooner.
- ‘Disruptive mood dysregulation disorder’ is a new definition for children over the age of 6 who suffer from chronic irritability and burst out in anger, three or more times per week for more than a year.
- The use of one overarching definition for autism spectrum disorder, including what are now separate diagnoses for Asperger’s syndrome, childhood disintegrative disorder and PDD-NOS (pervasive development disorder not otherwise specified.)
The autism definition changes have been particularly controversial. Families desperately need help to identify and treat children as soon as possible, because early diagnosis and early treatment called Intensive Behavioural Intervention can lead to better outcomes. The fear is that some children may not be identified if the separate categories disappear. Autism rates are rising in North America, with the recent stats showing it affects one in 88 children under the age of 8.
The Neurodevelopmental Disorders Working Group for DSM-5 states: “The change signals how symptoms of these disorders represent a continuum from mild to severe, rather than being distinct disorders. The new category is expected to help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, instead of providing general labels that tend not to be consistently applied across different clinics and centers.” Read more about the Working Group’s commentary on the definition change here.
Canadian scientists working in autism research see the move as a positive one, as reported here. The genetic researcher I spoke with for an earlier story, New Insights Into What’s Driving the Autism Epidemic, said that there there is simply too much variation to limit the disorder to three categories, especially since there are now more than 1000 different genes that play a role in the development of autism.