U.S. Psychiatrists Finish Revisions on Mental-Disorder Manual | TIM...

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Redefining Crazy: Changes to the Bible of Psychiatric Disorders

By John Cloud Dec. 03, 2012 172 Comments

On Saturday, the American Psychiatric Association (APA) finalized a 13-year process of revising the Diagnostic and Statistical Manual of Mental Disorders, commonly no!n as the DSM, the most important "oo in the field of mental illness# $he DSM attempts to designate and code all the !ays our minds can go a!ry# %t defines depression, an&iety, schizophrenia ' as !ell as more than 3(( other pro"lems from o"sessive-compulsive disorder to stuttering to fetishism# %nsurance companies re)uire DSM codes for reim"ursement, and the *ational %nstitutes of +ealth re)uire them for research grants# %t,s no e&aggeration to say that the ne! DSM ' the fifth full edition, one that more than 1,-(( mentalhealth e&perts help !rite ' !ill change the !orld of mental health# +ere are some of the "iggest changes. 1# Autistic disorder !ill "ecome autism-spectrum disorder# $hat spectrum !ill incorporate Asperger,s syndrome, !hich generally involves milder forms of autism,s social impairments and previously had its o!n code num"er (/00#1()# $o guide clinicians, the DSM !ill include specific e&amples of patients meeting criteria for the different disorders ma ing up the spectrum, from autistic disorder to Asperger,s, childhood-disintegrative disorder and pervasive developmental disorder (not other!ise specified)# 2om"ining autism and Asperger,s is especially controversial partly "ecause autism can "e so much more serious than Asperger,s# Although some autistic people function e&tremely !ell (the livestoc e&pert $emple 3randin has helped change her field), others affected "y the disorder need lifelong care for "asic needs# $he change !ill li ely cause considera"le de"ate, ho!ever, since the diagnosis is a re)uirement for access to some of the educational and social services that ma e up this care, and it,s not clear yet ho! the change in definition !ill affect such eligi"ility in the future# (MORE: DSM-5 4e"ate. 2ommittee 5ac s Off Some 2hanges, 6eopens 2omments) /# Binge-eating disorder !ill "e moved from DSM7s Appendi& 5 ' a category of proposed conditions that re)uire 8further study9 ' to a full-"lo!n illness in the main part of the "oo # $he shift !ill create a significant ne! mar et for mental-health professionals !ho !ill no! "e a"le to apply for insurance reim"ursement for patients !ho "inge eat# A ma:or criticism of considering "inge eating a distinct disorder is the difficulty in distinguishing !hether consuming an entire pint of 5en ; <erry,s could "e a sign of depression or an&iety rather than an illness of its o!n# 5ut in recognizing recent research that suggests that there are uni)ue features to "inge eating involving distorted-"ody-image issues, the APA in its press release on the DSM changes says that 8the ="ingeeating-disorder> change is intended to "etter represent the symptoms and "ehaviors of people !ith this condition#9 3# $he ne! DSM !ill remove the e&ception for "ereavement from the definition of depression, !hich means psychiatrists !ill "e a"le to diagnose depressive disorder even among those !ho have :ust lost a loved one# ?or years, s eptics have criticized the APA for its e&pansive meaning of depression@ no! that definition is even "roader#
Psychiatric association approves changes to diagnostic manual CNN
PATRICK TOURNEBOEUF / TENDANCE FLOUE

A sofa in a psychoanalyst's office, Paris, France.

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A# 2ontinuing the e&pansion of diagnostic criteria, the ne! DSM !ill also include a controversial ne! diagnosis called 8disruptive mood dysregulation disorder (4B44),9 a la"el that can "e attached to 8children !ho e&hi"it persistent irrita"ility and fre)uent episodes of "ehavior out"ursts three or more times a !ee for more than a year#9 Carlier this year, the +uffington Post called 4B44 the 8tantrum diagnosis,9 and a "logger for Wired !arned that the ne! disorder 8could "e anything, li e the meltdo!n !hen the shoes can,t "e found, the home!or got lost, or the "raids aren,t )uite right#9 5ut the APA says the ne! diagnosis 8is intended to address concerns a"out potential over-diagnosis and over-treatment of "ipolar disorder in children#9 (MORE: $he $rou"le !ith $al $herapy) -# DSM-5 !ill also incorporate the e&tremely rare disorders of e&coriation (s in pic ing) and hoarding# $he current DSM does list trichotillomania (o"sessive hair pulling), "ut adding reality-sho! pro"lems such as s in pic ing and hoarding has "olstered criticisms of diagnosis creep# +oarding !as previously considered a form of o"sessivecompulsive disorder# Dhat !ill not "e added to the 4SB is hyperse&ual disorder ' se& addiction ' even though many APA mem"ers argued for its inclusion# According to one mem"er of the APA,s "oard of trustees. 8$he evidence :ust !asn,t there#9 Other mental-health professionals note that the 4SB is su":ect to political influence# 8$his is a huge moneyma er for the American Psychiatric Association,9 says Barsha Einehan, a Fniversity of Dashington professor and a leading e&pert on personality disorders# $he decisions reflect the votes of the APA,s "oard of trustees@ the entire mem"ership !ill vote on the revisions later in the spring, "ut e&perts don,t e&pect additional alterations# Dhich means that the approval this !ee end of DSM-5 ends years of editing "ut "egins years of de"ate# MORE: Dhat 2ounts as 2razyG

John Cloud @JohnAshleyCloud

John Cloud is a senior writer at Time. He covers social and psychological issues for the magazine and for time.com, and you can follow him on Twitter @JohnAshleyCloud.

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12/12/2012 12:33 a.m.

U.S. Psychiatrists Finish Revisions on Mental-Disorder Manual | TIM...

http://healthland.time.com/2012/12/03/redefining-crazy-the-bible-of-p...

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12/12/2012 12:33 a.m.