The essential reference tome of the world’s psychiatrists is getting its first major update in 30 years. Due for publication in May 2013, Ferris Jabr has a great and detailed summary of the challenges, changes and history of the Diagnostic and Statistical Manual of Mental Disorders. Some highlights of the new edition:
- They’ve eliminated several diagnoses (including the controversial “childhood bipolar disorder”)
- They’ve combined several groups of related disorders (including officially grouping Asperger’s and CDD into “Autism Spectrum Disorders”) and increased the number of symptoms one must display to be diagnosed.
- They’ve added several new diagnoses, including binge eating disorder, gambling addiction, and both hypersexual and absexual disorder.
- They got rid of the Roman numerals.
Doctors and publishers have been more transparent in revising this version than in the past (posting drafts online for comment), but concerns remain. Although psychiatrists want to ensure that diagnoses are only given to those who meet certain criteria, will increased stringency prevent some high-functioning people from receiving needed treatment? How strong is the biology behind many of the criteria and distinct diagnoses? Will insurance companies and doctors continue to struggle with “gray-area” patients?
The debates surrounding the manual’s revisions are not merely back-office chatter. Although many psychiatrists do not sit down with the DSM and take its scripture literally—relying instead on personal expertise to make a diagnosis—the DSM largely determines the type of diagnoses clinicians make. Insurance companies often demand an official DSM diagnosis before they pay for medication and therapy. Many state educational and social services—such as after-school programs for kids with autism—also require a DSM diagnosis. Consequently, psychiatrists cannot dole out diagnoses of their own invention. They are bound to the disorders defined by the DSM.
SciAm will be publishing a week-long blog series about the new DSM-5. Highly recommended.