Psychiatrists Struggle to Update Mental Health DSM

A recent article reports on the daunting task ahead of psychiatrists: determining which illnesses, issues and disorders will make it into the next edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V. At the annual American Psychiatric Association’s meeting in Honolulu, psychiatrists discussed which personality disorders to eliminate from the manual. The proposal calls for reducing the number from 10 to five, eliminating several frequently diagnosed illnesses including narcissism. The DSM was first published in 1952, as a guidebook for the military. However, over the past half a century, its significance has become paramount as modern research has clouded the distinction between mental and physical conditions.

The latest version of the DSM is scheduled for print in 2013. Since its last revision in 1994, researchers have revealed volumes of data addressing the biological influences on disorders such as depression, anorexia and schizophrenia. However, many brain imaging tests suggest that these findings are not suitable for diagnostic purposes at this time. The psychiatrists faced with the challenge of updating the DSM must decide how to determine if a behavior is outside the realm of normal and should have a place within the DSM. Many involved in the decision-making are concerned that any deletions or additions to the DSM could do damage to the mental health field. “The brain is so darn complicated,” said Dr. David Axelson, director of the Child and Adolescent Bipolar Services program at the Western Psychiatric Institute in Pittsburgh.

Some of the suggestions on the table seem harmless, such as using the word “worry” in place of “anxiety”. However, changing the word “addiction” to “substance-use disorder”, or any other seemingly simple semantic swap could have a significant impact. Dr. David J. Kupfer, the DSM-V task force chairman and director of research at Western Psychiatric Institute and Clinic, said, “We have to be very careful about our choice of language and precise criteria. Slight word changes could translate into making a disorder much more prevalent – or much more rare.”

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Hadley

    Hadley

    May 26th, 2011 at 4:41 AM

    I guess I don’t see what the big deal is. If changing the terminology leads to better diagnosis and treatment for patients then it is really a no brainer. get the wording changed so that the true meanings can be better understood and get patients the help that they need, or at least the resources that can help them to get to someone who can.

  • Rene

    Rene

    May 26th, 2011 at 11:21 PM

    So a revision takes place every 20 years?!

    They would be better off making this a real-time online manual that is updated as soon any any major breakthrough is made. That would be far more beneficial than following a manual published 20 years ago!

  • Kayleigh Lee

    Kayleigh Lee

    May 26th, 2011 at 11:37 PM

    I have to agree on changing worry from anxiety, but not addiction to substance use disorder. The first is easy to understand and define, but the second is just lengthening a word to make it…well, what I don’t know.

    Less offensive or politically-correct maybe? Is that the reason? That’s how I’m seeing it.

    Let’s call a spade a spade instead. Plain language and terminology we’re already used to helps everybody.

  • Doc LC

    Doc LC

    May 27th, 2011 at 4:42 AM

    We get too bogged down in terms and verbage when sometimes it is really simple to see that something is going on and help may need to be pursued for the person.

  • Ed

    Ed

    May 27th, 2011 at 11:58 PM

    Just a thought – Would it not be better to observe the things and factors surrounding the particular case and then judge or come to a conclusion rather than to follow a guide book?!

  • Alexander Hair

    Alexander Hair

    May 28th, 2011 at 12:53 AM

    Addiction can refer to more than substances alone. What about internet addiction for example? The blanket word of addiction works perfectly fine for what it accomplishes. Look up a list of addictions and your mind will be blown.

  • beckysullivan

    beckysullivan

    May 29th, 2011 at 9:31 PM

    It won’t make anything more common or rare solely because of a definition change.

    You can widen the range of the symptoms, but one thing all psychologists know is that a client can have many symptoms of a condition and turn out not to have the actual disorder after all.

    That’s often very quickly forgotten.

  • Drew Silva

    Drew Silva

    May 29th, 2011 at 11:25 PM

    If they are saying it’s not suitable for inclusion as a formal diagnosis yet, then that’s the end of it. Mistakes happen in research, and we don’t need misdiagnoses or misrepresentation of crippling mental problems.

    Let’s leave them as they are until we can say with absolute certainty they deserve inclusion in the DSM-V or that renaming existing ones would be a good thing. Any doubt at all about inclusion should be an immediate reason to dismiss it as a possibility.

    Ladies and gents of the American Psychiatric Association, remember the acronym: K.I.S.S..

  • Marc Adams

    Marc Adams

    June 2nd, 2011 at 3:46 AM

    @Drew Silva. Yes, K.I.S.S. indeed! As the doctor in the article said, “The brain is so darn complicated.”

    Yes, but the DSM-V needn’t be! We don’t fully understand how the brain works and we shouldn’t casually mess with the Diagnostic and Statistical Manual of Mental Disorders on a whim.

    I suspect only a psychiatrist on an ego trip who wants to make their mark for posterity on the manual considers changing a name that we’re all perfectly happy with!

  • Summer Quinn

    Summer Quinn

    June 3rd, 2011 at 7:15 PM

    @Hadley The big deal is that some of the criteria hasn’t been fully researched to discern the impact of such changes. It become ambiguous, unclear or too generalized if too much tweaking goes on.

    That’s not good for the client or the therapist. Who benefits? No one. And what about all those that currently qualify for help only to see their condition obliterated from the manual? What a paperwork nightmare that would be.

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