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Proposed changes to psychiatry's 'diagnostic bible' are released

The long-awaited proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the “diagnostic bible” of the American Psychiatric Association, were released Tuesday.

Already, individuals, physicians, special-interest groups and others are expressing concerns with the revisions. Those critics will undoubtedly become more vocal as they read through the fine print of the draft document, which has been posted on the APA’s website for public review.

Other people, however, are welcoming some of the changes, as it will make it easier to receive insurance coverage for the treatment of certain symptoms of mental illness.

Of course, the whole decade-long process of revising the manual has stirred up considerable controversy. Most notably, the task force overseeing the project has come under heavy criticism for being tied too closely to the drug industry. In 2008, the consumer watchdog group Integrity in Science (a project of the Center for Science in the Public Interest) reported that more than half of the task force members had financial conflicts of interest. Some of those conflicts were small; others were extensive. One task force member, for example, had worked as a consultant for 13 different drug companies. [Full disclosure: I once worked for the Center for Science in the Public Interest.]

To counter that criticism, task force members agreed to not take more than $10,000 per year from the pharmaceutical industry while they revised the new DSM.

Here’s what I’ve pieced together from press reports and press releases about the major changes that appear in the draft document.

  • The separate diagnosis of Asperger’s disorder, generally considered a mild form of autism, is gone. People with symptoms of Asperger’s will now be diagnosed under the broader category of “autism spectrum disorders.”
  • A new category of “behavioral addictions” has been created. There had been speculation that Internet addiction and sex addition would be included in this category, but neither made the cut. Gambling, however, did.
  • Binge eating now has its own diagnostic category, separate from bulimia. (Binge eaters do not purge.)
  • Out of concern that too many children are being misdiagnosed with bipolar disorder (and thus treated unnecessarily with powerful drugs), a new mood disorder — temper dysregulation with dysphoria (TDD) — has been identified. Symptoms of this new disorder include moodiness, anxiety, irritability and bursts of rage.

These and the other proposed changes aren’t set in stone. The task force says it welcomes public input, and the final version of the new DSM isn’t scheduled for publication until May 2013. The last edition of the manual was published in 1994.

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Comments (1)

Thanks very much. Glad you are watching DSM.

Robert Spitzer, the psychiatrist who created DSM-III, appears in "The Trap" (an Adam Curtis BBC film). He doesn't know how many normal peoples' behavior has been "medicalized" by DSM, possibly 20 or 30 percent. (He says this in part 2 at about 33 or 34 minutes.)