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January 2011



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By John M Grohol PsyD 

Tomorrow will mark the release of the first public draft of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — also known as the DSM-V. (As you can see, we have an exclusive first-copy of it to the right!)

Because we were not on the American Psychiatric Association’s media list, we didn’t receive a copy of the news releases that the mainstream media will be basing a lot of their stories around that will be published tomorrow. We also weren’t invited to the conference call today, despite our repeated attempts to contact the APA’s media office.

This turns out to be good news for our readers. I’m free to talk about what I suspect will be in the draft that appears on the dsmv.org website tomorrow. I gathered this information from numerous anonymous sources, both online and off. Here’s what you’re likely to find in tomorrow’s draft release of the DSM V:

Autism Spectrum Disorders

As we first noted back in November, Asperger’s Syndrome is slated for the chopping block in the DSM-V. Instead, all the autism-related disorders — including Asperger’s — will be placed into a general category known as Autism Spectrum Disorders. Asperger’s will probably be known as something similar to “mild autism” in this new category in the DSM-V.

Behavioral Addictions

Yes, you heard me right — behavioral addictions as a category has made it into the draft revision (according to our sources). The only behavioral addiction that will be recognized, however, will be pathological gambling. Sex addictionInternet addiction (which, remember, started off as a joke in 1995) will instead appear in the Appendix under the Criteria Sets and Axes Provided for Further Study. In other words, the concept of a “behavioral addiction” will be recognized, but most specific behavioral addictions simply do not have the robust research base to be included at this time. So while technically in the DSM V, Internet addiction and sex addiction are not disorders that can be diagnosed at this time (by providing an agreed-upon set of criteria, the DSM V publishers hope researchers can use the criteria to further research in those areas). and

Substance & Alcohol Dependence Gone

For a long time now, the DSM-IV has made the distinction between someone who was “abusing” alcohol or illegal substances like cocaine, and those who were “dependent” upon them. It was a difference with very little distinction or use amongst clinicians, since substance abuse and alcohol abuse treatment were largely the same no matter which of the two diagnoses you received. DSM-V will rectify this confusing two sets of diagnoses and combine them into one that will have a set of specifiers to note severity and length.

Binge Eating Disorder

Languishing in the categories needing further research for 16 years, binge eating disorder will now be a recognized eating disorder in the regular section of the DSM V. This will come as a relief to tens of thousands of people every year who have this concern, but have not had it officially recognized by the American Psychiatric Association until now.

Dimensional Assessments

As we noted way back in May of last year, one of the most significant changes in the DSM-V draft will be the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across most mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner. We’re not certain how well these catch on with clinicians unless they become required by insurance companies, as past efforts to supplement diagnoses with additional patient functional information have been failures.

Assessing Risk

Prodromal signs is a fancy psychobabble term for assessing risk and looking for the signs of a disorder before it turns into a full-blown disorder. Imagine if we could more reliably and consistently assess risk for depression, actually preventing some people from becoming full-blown depressed? I’m not certain exactly how this is showing up in the draft, but there will be more of an emphasis in the DSM V draft in assessing risk.

Temper Dysregulation in Children

High emotional reactivity, high temper, emotional over-reactivity and affective lability. Now there’s a mouthful! What did I just say? The interpretation of this new proposed disorder for the DSM-V is basically for children who can’t control their temper (you probably know someone like this in your life), and because of the way their anger spills out into their lives, they suffer from depression. It will be characterized by persistent negative mood with bursts of rage. So this new disorder will be known as “Temper Dysregulation with dysphoria,” or something like that, in the DSM V.

So there you have it — a quick rundown of the highlights that you’ll see in the draft public release of the DSM-V tomorrow. Look for it at www.dsmv.org. We’ll have a more in-depth run-down tomorrow about the biggest changes.

Source:  http://psychcentral.com/blog/archives/2010/02/09/a-look-at-the-dsm-v-draft/

Psychiatrists propose changes in how doctors diagnose and name mental disorders

WASHINGTON — Don’t say “mental retardation” – the new term is “intellectual disability.” No more diagnoses of Asperger’s syndrome – call it a mild version of autism instead. And while “behavioural addictions” will be new to doctors’ dictionaries, “Internet addiction” didn’t make the cut.

The American Psychiatric Association is proposing major changes Wednesday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what’s officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them.

The manual suggests some new diagnoses. Gambling so far is the lone identified behavioural addiction, but in the new category of learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don’t purge.

Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders – such as dementia or schizophrenia – based on early symptoms, even though there’s no way to know who will worsen into full-blown illness. It’s a category the psychiatrist group’s own leaders say must be used with caution, as scientists don’t yet have treatments to lower that risk but also don’t want to miss people on the cusp of needing care.

Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

But overall the manual’s biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses – and urge doctors to concentrate more on the severity of their patients’ symptoms. Thus the draft sets “autism spectrum disorders” as the diagnosis that encompasses a full range of autistic brain conditions – from mild social impairment to more severe autism’s lack of eye contact, repetitive behaviour and poor communication – instead of differentiating between the terms autism, Asperger’s or “pervasive developmental disorder” as doctors do today.

The psychiatric group expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.

“Is someone really a patient, or just meets some criteria like trouble sleeping?” APA President Dr. Alan Schatzberg, a Stanford University psychiatry professor, told The Associated Press. “It’s really important for us as a field to try not to overdiagnose.”

Psychiatry has been accused of overdiagnosis in recent years as prescriptions for antidepressants, stimulants and other medications have soared. So the update of this manual called the DSM-5 – the Diagnostic and Statistical Manual of Mental Disorders, fifth edition – has been anxiously awaited. It’s the first update since 1994, and brain research during that time period has soared. That work is key to give scientists new insight into mental disorders with underlying causes that often are a mystery and that cannot be diagnosed with, say, a blood test or X-ray.

“The field is still trying to organize valid diagnostic categories. It’s honest to re-look at what the science says and doesn’t say periodically,” said Ken Duckworth, medical director for the National Alliance for the Mentally Ill, which was gearing up to evaluate the draft.

The draft manual, posted at http://www.DSM5.org, is up for public debate through April, and it’s expected to be lively. Among the autism community especially, terminology is considered key to describing a set of poorly understood conditions. People with Asperger’s syndrome, for instance, tend to function poorly socially but be high-achieving academically and verbally, while verbal problems are often a feature of other forms of autism.

“It’s really important to recognize that diagnostic labels very much can be a part of one’s identity,” said Geri Dawson of the advocacy group Autism Speaks, which plans to take no stand on the autism revisions. “People will have an emotional reaction to this.”

Liane Holliday Willey, an author of books about Asperger’s who also has the condition, said in an email that school autism services often are geared to help lower-functioning children.

“I cannot fathom how anyone could even imagine they are one and the same,” she wrote. “If I had put my daughter who has a high IQ and solid verbal skills in the autism program, her self-esteem, intelligence and academic progress would have shut down.”

Terminology also reflects cultural sensitivities. Most patient-advocacy groups already have adopted the term “intellectual disability” in place of “mental retardation.” Just this month, the White House chief of staff, Rahm Emanuel, drew criticism from former Republican vice-presidential nominee Sarah Palin and others for using the word “retarded” to describe some activists whose tactics he questioned. He later apologized.

AP Medical Writer Lindsey Tanner in Chicago contributed to this report.

Source:  http://www.google.com/hostednews/canadianpress/article/ALeqM5h5A7Uy-3KlpRahG0oqcOoSpIrxWA

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