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New mental health diagnostic manual debuts

A draft of the DSM V is out, with some significant changes in mental health diagnostic criteria. Few of the revisions affect diagnosis of mood disorders. Critics say there should have been more.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is used by mental health professionals in the United States to identify and categorize mental disorders. Its classifications provide a common language between doctors, researchers and others in the field. It is used in the development of new drugs. It’s also used by insurance companies, which generally require a DSM mental disease diagnosis to authorize payment for mental health services.

The fifth edition of the book will be published in 2013. The APA has published a draft of DSM-V on their web site where it is inviting comments from the public through April 20.Some of the changes in the DSM V include:

  • Changes in criteria and new categories for learning disorders and a single diagnostic category, “autism spectrum disorders.”
  • Replacing “substance abuse and dependence” with the new category “addiction and related disorders.”
  • A new category of “behavioral addictions” that includes only gambling.
  • New recognition of body image disorder, binge eating disorder and improved criteria for anorexia nervosa and bulimia nervosa.
  • A new “risk syndromes” category to help clinicians identify earlier stages of some serious mental disorders.
  • New suicide scales for adults and adolescents to help clinicians identify those individuals most at risk.

Children diagnosed with bipolar disorder
A new category that indirectly impacts the diagnosis of mood disorders is the proposed new disorder for children called “temper dysregulation with dysphoria” for “persistent negative mood with bursts of rage.” This new behavior disorder is expected to apply to many of the growing numbers of children currently being diagnosed with bipolar disorder. Recent studies have shown that many of these children, who may be aggressive and irritable, do not have bipolar disorder. Rather than powerful antipsychotic drugs, the primary treatment may be behavioral.

Mixed Anxiety Depression
This new diagnosis combines some of the symptoms of major depression with anxious distress. Critics argue that its definition is too broad and would apply to vast numbers of the population.

What’s missing?
Categories and criteria for mood disorders remain largely unchanged.

For many years, bipolar disorder experts have been referring to bipolar disorder as a “spectrum disorder” rather than as two distinct diagnoses – Bipolar I and II – with symptoms that occur from one end of a continuum to another. Many of them had hoped to see this view reflected in the new DSM.

“I’m deeply disappointed,” says psychiatrist Jim Phelps, MD., Samaritan Mental Health, Corvallis, Oregon.  “I fear we’re in for continuing controversy about whether there is a middle ground between bipolar and unipolar, for another decade. Meanwhile, patients and families will create the change. They will start arriving at the psychiatrists’ offices with completed bipolar screening tools (e.g. Mood Disorders Questionnaire or Bipolar Spectrum Diagnostic Scale, including the rest of the Bipolarity Index. Then the psychiatrists will be forced to keep up. Of course some will, and some will push patients’ efforts away, just as they do now…  But over time, change will come and this time patients and families will drive it, probably more than the DSM committees.”

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