Would introducing a category for the risk of psychosis promote early diagnosis that leads to better treatment? Or will it promote unnecessary worry, stigma and giving drugs to young adults who don't need them? These are among the questions posed by the release of the American Psychiatric Association's newest version of the Diagnostic and Statistical Manual (DSM-V).
Many are eager to weigh in about the fifth revision of what's been called psychiatry's "bible." It has been a decade-long process involving hundreds of researchers and psychiatrists and no small measure of controversy. For the APA, it the begins the final stage of a process that includes two months for public comments and then field testing before 2013 when it becomes final.
A blizzard of headlined announcements accompanied the release. NPR's All Things Considered, gave it top billing, New York Times, a front-page story, and the PBS New Hour devoted nearly 10 minutes to an interview with two prominent psychiatrists.
What does this mean? Some worry that there is a tendency to pathologize normal behavior while others see it as an opportunity to identify more precisely treatable conditions before they are out of control. Blood tests, x-rays, or microscopes, the biological markers used throughout medicine, are lacking in psychiatry. Instead it has built a menu of choices about mood, behaviors or functionality to make a diagnosis. Often these need a revision informed by new information, as was the case with the DSM-IV.
The DSM-V adds a measure to scale severity for each group. Some of the many other changes include: revising bipolar disorder in youth, eliminating sub-types of personality disorder and also of schizophrenia, adding binge eating to eating disorders. Aspergers Syndrome is now part of a spectrum of autistic disorders, substance use disorders will fall under "addiction and related disorders.
In addition to creating the lingua franca for students, educators, and practitioners, the DSM creates categorical references to research, becomes the standard by which insurance decides reimbursement, and is used as a reference point for marketing by drug companies. In other words, a lot rides on this book..
To review and comment on the work of the groups, click "Proposed Revisions" on this page.
I am an advocate who has grappled for thirty years with public misconceptions concerning psychiatric conditions. The DSM-5 offers a very rare opportunity to clarify or abolish psychiatric terms that confuse laypeople.
Unfortunately, in its Proposed Draft Revisions, the DSM-5 authors have perpetuated a very confusing clinical term, “schizophrenia.” Included on a list of 17 generalized classifications (such as “dissociative disorders,” “mood disorders,” and “eating disorders)” is the anomalous “schizophrenia and other psychotic disorders.”
Why not call the category “psychotic disorders”? Why focus attention on a word that is widely misunderstood? For over thirty years, “schizophrenia” has been a constant source of confusion. The archive of the National Stigma Clearinghouse shows that even highly-placed mental health professionals have misused the word to mean “self-contradictory.” Our files became so crammed with examples of popular misuse of “schizophrenia” that we stopped collecting them.
It now appears that the DSM-5 will highlight rather than downplay or replace this most problematic psychiatric clinical term. Let's hope this is an oversight that can be easily corrected.
The APA is to be applauded for opening this massive project to public scrutiny on a special website.
Posted by Jean Arnold | February 13, 2010 11:14 AM
First of all, the DSM is for diagnosis, not treatment.
Second, the contributors are deeply enbedded with industry.
Third, there is still not one objective methodfor diagnosis: all diagnoses are clinical diagnoses.
Fourth, people are given diagnoses of subclinical disorders and are given drugs even if they do not meet the criteria outlined in the DSM for a disorder. For example, a person may have three symptoms toward the five criteria for major depressive disorder (MDD) so does not meet the threshold for the diagnosis. But they are said to have subclinical MDD and are given drugs. This is even more pronounced with the symptoms of psychosis, which can be attached to more and more people for practically anything from withdrawal of social contacts to just smoking a lot of pot.
Fifth, children and adolescents are judged very severely and said to have all types of disorders, epecially those young people in foster care, poverty and other challenging life situations.
wont' let me type more here...sorry
Posted by Eileen McGinn | February 11, 2010 4:26 PM