Understanding the Controversy Behind the Changes in the DSM-5

Girl leaning on fenceThe American Psychiatric Association has approved changes to the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM. The fifth edition of the flagship guide to psychiatric diagnosis, due for release in May 2013 and known as the DSM-5, features several controversial revisions.

The DSM establishes criteria for the diagnosis of mental health conditions. Because changes to the manual can affect insurance coverage for certain issues and help define “normal” behavior, advocacy groups are often concerned about the effect additions and alterations will have. The latest revision is no exception.

Children and Mental Health
Diagnosing children with mental health conditions is often dicey because of concerns about stigma and the use, or overuse, of psychiatric drugs. At a time when some groups argue that fewer children should be diagnosed with mental health issues, the DSM-5 adds new diagnostic criteria for children. Those over the age of 6 who display irritability or frequent angry outbursts now qualify for a diagnosis of disruptive mood dysregulation disorder. While some mental health professionals emphasize that this new diagnosis could make it easier to plan early intervention for children who have extreme difficulties controlling their emotions, some advocacy groups have expressed concern that such a diagnosis could stigmatize normal childhood behavior or lead to the prescribing of unnecessary drugs to young children.

Autism Spectrum Disorder
The DSM-5 eliminates Asperger’s syndrome, folding it into a broader category called autism spectrum disorder. Diagnoses of Asperger’s and autism have been steadily increasing over the past several years, and many children with less severe symptoms of autism have been diagnosed with Asperger’s. The DSM-5, however, incorporates several autism-like issues, including Asperger’s, into the diagnosis of autism spectrum disorder. Not everyone is happy with this change. Many people with Asperger’s view the issue as part of their identity and do not want it to be lumped in with other issues. The APA, however, argues that this change will make diagnosis of autism more consistent and access to treatment easier.

Grief and Depression
Previous versions of the DSM incorporated a bereavement exception into depression diagnoses. This exclusion prevented mental health professionals from diagnosing a person who was grieving the death of a loved one with depression. The DSM-5, however, permits depression diagnoses in the bereaved. Members of the APA argued that the old bereavement exception excluded grieving people who had been diagnosed with chronic depression from being diagnosed with, and receiving treatment for, depression. But some people worry that the new changes pathologize grief and turn normal grieving—which often looks a lot like depression—into a mental health diagnosis.

Other Changes
The DSM-5 adds hoarding and excoriation disorder—a diagnosis for people who compulsively pick their skin. The APA also rejected several proposed disorders, including parental alienation syndrome, hypersexual disorder, and anxious depression. While the APA emphasized that the revisions—like all changes to the DSM—are intended to clarify diagnostic criteria and improve consistency in diagnosing, mental health advocacy groups argue that many diagnostic criteria have been loosened and that the DSM-5 will increase the number of people diagnosed with mental health conditions.

Which changes to the DSM did you find most controversial? Please share your comments below.


  1. Asperger’s syndrome dropped from American Psychiatric Association manual. (n.d.). MedPage Today. Retrieved from http://www.medpagetoday.com/Psychiatry/DSM-5/36206
  2. Gever, J. (n.d.). DSM-5 wins APA board approval. MedPage Today. Retrieved from http://www.medpagetoday.com/Psychiatry/DSM-5/36206
  3. Gupta, P. (n.d.). Controversial changes to stay in DSM-5. Salon. Retrieved from http://www.salon.com/2012/12/02/controversial_changes_to_stay_in_dsm_5/
  4. Spiegel, A. (2012, November 30). Weekend vote will bring controversial changes to psychiatrists’ bible. NPR. Retrieved from http://www.npr.org/blogs/health/2012/11/30/166252201/weekend-vote-will-bring-controversial-changes-to-psychiatrists-bible

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  • Kimberly J

    December 6th, 2012 at 11:41 AM

    I am a teacher and this article tripped a memory of a student I had. He was definitely overmedicated so his parents wouldn’t have to deal with his behavior. They would rather have him zoned out and blindly obedient than deal with his real behavior and who he really was. It was very sad for me and made me question how many doctors prescribe medication for children just to appease parents and/or (sadly enough) teachers.

  • Someone

    January 29th, 2013 at 7:54 AM

    I agree Kimberly. Putting innocent little children on anti-psychotics / neuroleptics / major tranquilizers that “disable” their brain or anti-depressants with FDA box warnings that state the drugs cause mania, suicides, and violence is sickening and wrong. There is no scientific evidence of “chemical imbalances” in the brain, other than those the psychiatrists are causing with their drugs. And an industry that is intentionally trying to profit off stigmatizing and drugging up the weakest in society may be bringing in big bucks for it’s members, but it’s morally bankrupt.

  • Parnella

    December 6th, 2012 at 3:29 PM

    Im no expert but I hope these changes have been affected with the help and support of research findings and that no commercial interests such as insurance companies have had any influence.our understanding of disorders is bound to change with time,with more studies and research done on them but putting that change in a way which benefits the most people should be the focus.most people being the clients and patients in this case.

  • Fallon

    December 6th, 2012 at 4:51 PM

    I just don’t see what all the fuss is about. We are an ever changing and evolving field, and we should be glad that the spectrum of diagmnosis is so much broader. I am glad and hopeful that the changes mean that many more people who are in need of continuos and on going mental health care will now have access to that care as well as answers for many of their problems that they have lived with all their lives. I know that change can sometimes be difficult and scary but I think that this is one time where the change is going to be for the better.


    December 6th, 2012 at 11:28 PM

    There’s always going to be critics.Its just not possible to get everybody to agree with any position you take,whether you’re an individual or group.Im sure a lot of people criticizing the changes in the new DSM do not even understand psychology/psychotherapy.But as long as the changes affecte are based on scientific evidence and the general trend observed I think we should be happy with the end product.Maybe the APA should conduct a study on the reactions to the new DSM?Now that would be interesting!

  • Randi Salinas

    December 7th, 2012 at 1:49 AM

    I was disheartened to see some of the replies on this issue. I often wonder, “If only other parents’ could see what I see, ” My child has been diagnosed with Severe Mood Dysregulation and ADHD; and her drugs include: Risperdal (antipsychotic), and Adderall. She is responsibly medicated with check ups and therapy once per week. She made incisions in her wrist at under 4 years of age…This is just unacceptable. She belongs to a loving, 2 parent family and receives plenty of attention. It concerns me with the overwhelming amounts of stigma attatched to this consensus of children being affected with mental illness….if children all around the world can have Diabetes…Why can’t they have a mental illness….This boggles my mind; yes some children are underdiagnosed, but more importantly, more children are MISDIAGNOSED…check statistics… Here’s a question–would you rather have your child committ suicide or take medication…this should be a no-brainer. Also, for relevance, my sister committed suicide at 10 in 2000, and belonged to a loving family with no signs of any abuse; clearly there was a depression issue that we failed to see because people at that time suggested that such an issue was absurd, and my sister was the 4th person in the 10-15 age group to committ suicide in 2000. Get with the change people: Breeding with other people with a history of mental illness = higher chance of childhood psychosis in offspring. ~ Follow my blog for more opinions and stories

  • Pascal

    December 7th, 2012 at 12:56 PM

    @Randi:I am sorry about your sister and am empathetic about your daughter.

    Please understand that not everybody has the problem of non-diagnosis or mis-diagnosis.There are and will be cases of diagnosis where there is no issue.There is no way to have a blanket rule to this.

    The best we can do is to tweak our medical practices and diagnosis methods so that those with a problem are diagnosed and those without are not.That should be the ultimate aim of DSM.

  • Randi Salinas

    December 7th, 2012 at 3:40 PM

    @Pascal – You are absolutely right in stating that not everyone has the problem of non-diagnosis and misdiagnosis; The DSM will never please everyone and this I know; however, I feel that the real problem is people who are uneducated on this issue and put a bad name on the reality of childhood mental illness.

  • Nate Watkins

    May 3rd, 2013 at 11:16 AM

    please sign this if you’re against the DSM 5’s changes: change.org/petitions/dsm-5-committee-dont-reduce-the-criteria-for-an-autism-spectrum-condition-in-the-dsm-5

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