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.
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