The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the ultimate encyclopedia of the mind, and the primary resource for physicians charged with assessing mental ailments such as clinical depression, eating disorders and autism. Despite advances in genetic screening and brain scans, mental illness diagnosis still relies on written descriptions, which makes the DSM immeasurably influential.
American Psychiatric Association
Proposed changes to the DSM would have major implications for a variety of mental illnesses.
"This has been a massive effort on the part of a very dedicated team," Dr. David Kupfer, chairman of the APA committee, said in a public statement. "Their priorities were to make sure the manual is based on scientific evidence, is useful to clinicians and maintains continuity with the previous edition wherever possible."
The suggested revisions could have major implications for a wide range of mental illnesses, for children as well as adults, and even for those who display risk factors rather than outright symptoms. Legal decisions, government programs and even how we see ourselves, and one another, are all affected by the DSM.
The most controversial change under consideration is likely to be the addition of a new "at risk" category for patients displaying early symptoms of illnesses such as dementia and psychosis. Some experts are expressing concern that it could lead to stigmatization and misdiagnosis.
"There will be adolescents who are a little odd and have funny ideas, and this will label them as pre-psychotic," Robert Spitzer, a professor of psychiatry at Columbia University, told The Washington Post.
Several childhood disorders could be folded into a broadly defined category, called "autism spectrum disorders," that would include Asperger's and autistic disorder. The committee has also recommended a new diagnostic category called temper dysregulation disorder with dysphoria (TDD), which would apply to children who display symptoms of bipolar disorder.
Rather than treatment with anti-psychotics, doctors would turn to behavioral therapy for TDD patients. Because certain medications can have powerful side effects, especially in kids, the idea is likely to get strong backing from experts.
"About 40 percent to 60 percent of the cases will be children who are doing things that other people don't want them to do," Dr. David Shaffer, a psychiatrist at Columbia University who worked on the revisions, said in a statement to the press. "Many of these are children who are 'stubborn and resistant and disobedient and moody.' "
Eating disorder diagnostics also may undergo several changes. Binge eating, characterized by regular episodes of uncontrollable eating, often in secret, is estimated to afflict 3 percent of Americans. It will now be included in the DSM. The panel also suggested improving diagnostic criteria for anorexia and bulimia to reflect the potential for diverse symptoms that don't always fit a checklist.
Moving away from a checklist mentality was a major priority for the APA task force. Their suggestions also include new "dimensional" and "cross-cutting" elements in diagnoses. That means physicians would evaluate a patient for severity of symptoms, and also for symptoms that might not fit the standard definition of a particular illness -- for example, a schizophrenic patient who also suffers chronic insomnia.
Dr. Darrel Regier, research director at the APA, told the press that symptoms such as insomnia or anxiety might not fit the diagnosis of a patient's main illness, but "can still affect patients' lives and affect the treatment planning."
For the first time, compulsive gambling would also have its own set of criteria. The illness, currently referred to as "problem gambling," is estimated to afflict 1 percent of adult Americans. Internet addiction -- a condition that several experts pushed for -- didn't make the cut. The team decided there was "insufficient research data."
After receiving public input, the APA committee will revise the recommendations. It plans to publish the finalized version of the DSM in May 2013.
