The long-awaited revision of the Diagnostic and Statistical Manual of Mental Disorders ( DSM ) has been approved, bringing with it a series of revisions, additions and subtractions to the tome that is considered the Holy bible of psychiatry.
The modification, announced Saturday, has been more than a decade in the making and included input from more than 1,500 experts in all walks of medicine in 39 countries.
The changes to the DSM “will have some impact because there are some considerable changes in diagnostic criteria,” said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Slope Hospital in New York City. “The ramifications [will connect] not only to insurance protection but to what we consider psychopathology. That is definitely very much inspired by what the DSM says,” he added.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-4 ) has been in use since 1994. The fresh DSM-5 will become available in its entirety in the spring of 2013, relating to the American Psychiatric Association (APA), which posts the volume.
“We have produced a manual that best signifies the current technology and will be useful to clinicians and the individuals they serve,” APA chief executive Dr. Dilip Jeste said in a statement from the association.
Although the new manual will include roughly the same number of disorders as the one it is replacing, a number of changes in content are significant.
One of the biggest changes is a switch in nomenclature for “autistic disorder,” which will right now be known while “autism spectrum disorder.” That means Asperger’s syndrome, a less devastating form of autism, will become folded away into the larger category and no longer possess its personal status.
This change was met with some concern.
“Although there is a strong scientific explanation for these changes in the diagnostic criteria, we are concerned about the effect of the fresh DSM-5 criteria when they are used in real-world settings,” said Geraldine Dawson, key technology official of Autism Speaks, adding that the tests about the fresh criteria were based about a relatively small quantity of children.
“It is crucial that we monitor how the DSM-5 influences analysis and access to solutions in the real world,” she continued. “We need to make sure that no one is definitely excluded from obtaining a analysis and getting at solutions who demands them.”
Bruno said it was difficult to predict what type of effect the inclusion of Asperger’s within autism spectrum disorder would have on insurance protection and access to solutions. Many clinicians already consider Asperger’s part of the autism spectrum, he mentioned.
Another expert agreed.
Dr. Andrew Adesman, key of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park, said the fresh DSM is definitely “codifying or formalizing what specialists possess been performing informally for years.”
This is true not only for the term “autism spectrum disorder,” which is already in wide use, but also for the age cutoff for symptoms of individuals with the inattentive form of attention-deficit/hyperactivity disorder (ADHD). The fresh DSM stretches the age for sign manifestation to 14, said Adesman.
Also in the new DSM-5 , binge-eating disorder has been bumped up to a bona fide medical condition from one that just needed “further study.” With a formal code in hand, mental-health practitioners may right now become able to get insurance reimbursement for treatment attempts.
Children may also right now receive a analysis of “disruptive feeling dysregulation disorder,” a condition new to the DSM-5 , which is characterized by “persistent irritability and frequent shows of behavior outbursts three or more instances a week for more than a yr.”
Although the new diagnosis is intended to cut down on the number of children labeled with bipolar disorder, some say it simply medicalizes temper tantrums.
Bruno stressed, however, that the new disorder refers only to particularly severe tantrums that occur frequently. “This is definitely much more intense than a tantrum,” he explained. “There are definitely those kids where the tantrums and irritability are very chronic and very severe. A lot of kids who were captured by a bipolar analysis may become captured by this.”
Both excoriation (skin-picking) disorder and hoarding disorder are fresh to the DSM-5 and will appear in the chapter on “obsessive-compulsive and related disorders.”
In another controversial change, particular people who are going through grief can right now be diagnosed as having depression, an acknowledgment that “bereavement is a severe psychosocial stressor that can precipitate a major depressive episode,” according to a news launch issued by the APA.
Bruno believes that there will likely still be variations between “normal” suffering and suffering that is labeled major depression.
In additional changes, “gender identity disorder” is right now “gender dysphoria,” and dyslexia was not dropped from the manual, as some had feared might happen.
Also, excessive “Internet gaming” right now belongs to the category of conditions requiring “further research.”
And there was one notable condition not added to the DSM-5 : “hypersexual disorder,” which many in the lay general public refer to as sex addiction.
“The non-inclusion of sex addiction was not particularly amazing,” Bruno said, because usually this behavior occurs as a sign of additional disorders, such as personality disorders, and is not something that psychiatrists commonly treat.
“We rarely see this as an entity in and of itself,” Bruno said.
Dr. Elisa Hawks 