After more than a decade of contentious debate, the American Psychiatric Association voted Saturday to finalize the next version of its diagnostic guidebook, often referred to as the “bible” of the mental health field. It’s sure to keep the debate coming.
Among the most notable changes to the Diagnostic and Statistical Manual of Mental Disorders—the fifth version of which will be released in May 2013—is the incorporation of Asperger’s syndrome and autistic disorder into the catch-all category of autism spectrum disorder, a move that was long expected. Also included in this category will be childhood disintegrative disorder and pervasive developmental disorder. Previously, these issues were independent diagnoses.
Gaining popular acceptance as a treatable condition in the DSM-5 is binge eating disorder, which previously had been under review because its symptoms sometimes mirror those of mood issues such as depression and anxiety. As with other conditions listed in the DSM, adding binge eating allows mental health professionals to seek insurance reimbursement for a professionally recognized and legitimized issue. Although a diagnosis typically is necessary to receive certain social and educational services, it remains unclear how the DSM-5 will affect access to these resources.
“We developed DSM-5 by utilizing the best experts in the field and extensive reviews of the scientific literature and original research, and we have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve,” APA president Dr. Dilip Jeste said in a statement.
Folding Asperger’s syndrome into autism spectrum disorder has generated controversy in part because autism is generally considered a more serious issue. Children with Asperger’s often lack social skills, but those with autism are sometimes unable to talk or interact at all. Defenders of the move pointed out that some states and school programs do not adequately accommodate people diagnosed with Asperger’s. Linking the issue with autism may change that.
Also of note:
- The removal of the exception for bereavement in the DSM-5 paves the way for a diagnosis of depression without delay when a person is grieving the death of a loved one. The APA said this change is intended to acknowledge bereavement as a serious psychosocial stressor that can trigger a depressive episode.
- Disruptive mood dysregulation disorder joins the pages of the DSM. A diagnosis is applicable to children who display “persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year,” according to the APA. This change has generated criticism for its broad scope, which some fear could lead to an increase in clinical diagnoses for what many see as “normal” child behavior. Proponents of the change say it will help reduce diagnoses and treatment of bipolar in children, a growing concern.
- The term “gender identity disorder” will go away, replaced by “gender dysphoria.” Activists had criticized the terminology in the current DSM for being pathologizing and stigmatizing. A diagnosis of gender dysphoria may apply to people who are emotionally distressed about their gender identity.
- Hoarding, the compulsive collection of possessions that may or may not have monetary value, joins the DSM-5 as a separate condition from obsessive compulsive disorder. Excoriation (skin-picking) also will be incorporated in the new text.
- The DSM-5 expands on the current edition with regard to posttraumatic stress, with four diagnostic clusters instead of three and an increased focus on symptoms.
- Substance abuse and substance dependence, separate categories in the current DSM, will be combined into the broader designation of substance use disorder. Criteria for diagnosis were strengthened as well.
- Dyslexia, which many feared may be eliminated from the DSM, survived and will be included under the categorical umbrella of learning disorders.
- While the criteria for diagnosis are unchanged, pedophilia will be known as pedophilic disorder in the DSM-5.
- Designated as requiring further research will be attenuated psychosis syndrome, Internet use gaming disorder, nonsuicidal self-injury, and suicidal behavioral disorder. Categorizing these issues as such makes it unlikely that insurers will reimburse for their treatment.
- Several proposed issues did not make the cut for inclusion in the text, including hypersexual disorder (sex addiction), anxious depression, parental alienation syndrome, and sensory processing disorder.
- The DSM-5 will be arranged by relevant disorder rather than in a multiaxial format. Chapters will be positioned such that disorders that are related or similar in symptomology will be near each other.
The last version of the DSM to undergo significant revisions was published in 1994. Certain specifics of the DSM-5 will not be made public until its release, APA leaders said.
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