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January 2012



Recent Posts


New Definition of Autism Will Exclude Many, Study Suggests



Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.

The definition is now being reassessed by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply.

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Psychiatric Group Push to Redefine Mental Illness Sparks Revolt

January 27, 2012, 10:41 AM EST

By Elizabeth Lopatto

Jan. 24 (Bloomberg) — An effort that promises to broaden the definitions of mental illnesses is spurring a revolt among health-care professionals in the U.S. and the U.K.

A panel appointed by the American Psychiatric Association is proposing changes to the industry’s guide for mental illnesses, which determines how patients are diagnosed and treated, and whether insurers pay for care. The new edition of the Diagnostic and Statistical Manual of Mental Disorders is scheduled to be published next year.

The draft is sparking a backlash among practitioners concerned the expanding mandate will increase the number of patients treated with drugs. The guide would loosen diagnostic criteria on some existing ailments and brand as mental disorders some common behaviors, including having temper tantrums three times a week or a lack of sexual arousal. The changes may spur unneeded and dangerous treatment of the healthy, said Allen Frances, a psychiatrist who helped write the current guidelines.

“Everyday disappointments, sufferings and eccentricities are being redefined as psychiatric disorders, and that could lead to medication treatment,” said Frances, a professor emeritus at Duke University who lives in San Diego, California. “This is expanding the boundaries of psychiatry.”

In many cases, family doctors will use the new definitions to treat patients, Frances said by telephone. Pressure from drugmakers to use medications can combine with media representations to create “an epidemic,” he said. “Once primary care doctors and patients have the idea that they saw a certain condition on TV, it becomes real.”

‘Medicalizing Normality’

Darrel Regier, the psychiatric group’s research director, characterized critics as being unconvinced medical treatment is better than counseling. The idea of “medicalizing normality comes from a perspective that there are no psychiatric disorders, and you need to avoid stigmatizing people by giving them one,” he said in a telephone interview.

An Oct. 22 letter critical of the changes, sponsored by units of the American Psychological Association in Washington, was signed by more than 10,800 people, including psychologists, psychiatrists, counselors, and community activists. The British Psychological Association, based in Leicester, England, sent a similar letter in June 2011.

The letters identify changes such as the one affecting ADHD, or Attention Deficit Hyperactivity Disorder, a long- identified illness that involves hyperactive people who have difficulty staying focused and controlling behavior, according to the National Institutes of Health in Bethesda, Maryland.

ADHD Changes

In the present manual, a diagnosis for ADHD requires six symptoms to be identified in adults, including some present before age 7. The new manual requires only four to be identified and the disorder no longer must present itself in childhood.

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