Experts: Mental Health Bible Revamp Could Make Us All (Literally) Crazy

(July 27) -- An estimated one in four American adults already suffers from a mental disorder. But if suggested changes to a mental health bible relied upon by most doctors are approved, nearly no one will be classified as "normal" anymore.

That's the grim warning from a team of leading health experts, who today spoke out about proposed amendments to the Diagnostic and Statistical Manual of Mental Disorders (DSM).

"It's leaking into normality. It is shrinking the pool of what is normal to a puddle," warned Til Wykes, a doctor at the Institute of Psychiatry at Kings College London, in a statement reported by Reuters.

Here's a backgrounder on the growing controversy:

1. What is the DSM?

It's a veritable compendium of mental illnesses, from eating disorders to schizophrenia. The DSM includes symptoms, case studies and treatment options to assist doctors -- and pharmaceutical companies, researchers and health insurance companies -- in making important care decisions.

The DSM is compiled, edited and updated by the American Psychiatric Association (APA). It's been revised five times since 1952. This latest, controversial edition is slated for release in 2013.

2. What are the proposed changes?

After years of meetings and research, a 160-member APA panel released its recommendations for the revised DSM -- the first major revamp in 10 years -- in February.

The proposal includes a new "at risk" category, which would apply to those who exhibit early symptoms of illnesses like dementia and psychosis.

Other big changes: Kids with symptoms of bipolar disorder would suffer "temper dysregulation disorder," binge eating and compulsive gambling would become diagnosable illnesses and those with manageable symptoms might be diagnosed with "mild anxiety depression."

"This is the first major rewrite of DSM in 16 years and history has warned us that even small changes to this manual can have extraordinary repercussions in the diagnosis and treatment of mental health issues," said Daniel Falatko, managing editor of the Journal of Mental Health, which is running several papers on the DSM changes this month.

3. What are psychiatrists so worried about?

The experts who spoke out today expressed concern that the changes would lead to massive overdiagnosis -- and perhaps unnecessary medical and pharmaceutical intervention.

"Technically, with the classification of so many new disorders, we will all have disorders," the doctors wrote in a statement. "This may lead to the belief that many more of us 'need' drugs to treat our 'conditions' -- many of these drugs will have unpleasant or dangerous side effects."

Ritalin is one example cited by the team of a medication inappropriately prescribed after the DSM was amended in 1994 to broaden the criteria for children's ADHD and autism.

4. I think I'm fine -- should I be worried?

Not if you're working with a doctor who uses the DSM the way it was intended -- as a resource, not a diagnostic checklist.

"... Practitioners, if they use the manuals at all, use them in a loose, informal manner," Dr. James Phillips writes in Psychiatric Times. "[They're] comfortable ignoring diagnostic criteria and making their diagnoses following an informal prototypal pattern."

By adding more illnesses, categories and "risk" levels, the proposed edition of the DSM might give researchers and pharmaceutical companies more to work with. But for doctors, it'll likely be business -- well done or not -- as usual.

"Would we be looking to blame Merriam Webster for all of the trash romance novels that exist?" asks Dr. John Grohol at Psych Central. "Do we blame the DSM for poor diagnoses, or do we blame the professionals ... who make the poor diagnoses in everyday practice?"