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New Diagnostic Guidelines for Mental Illnesses Proposed

Suggested changes include not formally recognizing sex addiction, spotting those at risk for dementia
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HealthDay

Wednesday, February 10, 2010

HealthDay news imageWEDNESDAY, Feb. 10 (HealthDay News) -- For the first time in more than a decade, the American Psychiatric Association has announced proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM), long considered the "Bible" of psychiatry.

Unlike its predecessor, DSM-4, the new DSM-5 would not formally recognize sex and Internet addictions; would create a new category for "risk" disorders for people possibly heading towards developing full psychosis or dementia; and would create a new disorder, "temper dysregulation with dysphoria" (TDD) to incorporate both mood and behavioral disturbances, partly a response to current overdiagnosis of juvenile bipolar disorder.

Other issues were also addressed, including creating an overarching category known as "autism spectrum disorders" to encompass autism, Asperger's syndrome and other similar conditions. This term is already widely used. And "mental retardation" would become "intellectually challenged."

DSM is the tome used by psychiatrists and other mental health professionals to diagnose different conditions and to guide research.

The proposed draft will be available for public comment until April 20. The final document, which has already been 10 years in the making, is expected to be released in 2013. The DSM-4 was published in 1994.

One of the major changes in the proposed volume will be a move toward "dimensional assessments" for mental disorders, meaning that strict, immutable categories will be replaced by a reliance on continuums and that "cross-cutting" symptoms -- those that span several different disorders -- will be included in the criteria.

"There's no measure in the [DSM-4] to account for the severity of the disorder and therefore no way to measure if a patient, on quantitative measures, is improving with treatment," Dr. Darrel Regier, vice chair of the DSM-5 Task Force and director of research for the American Psychiatric Association, said during a Tuesday teleconference announcing the proposed changes. "We're trying to address this with more quantitative measures on a continuum with a cut-off to decide mild, severe, very severe."

This time around, experts say they are giving "careful consideration" to how mental health disorders might vary according to race, gender and ethnicity.

Some of the other proposed changes:

The DSM-4 was widely criticized for "overpathologizing" ordinary and expected human experiences and emotions.

"Every time the DSM is revised it gets bigger and there seem to be more and more disorders, and new ones seem to be invented," said James Maddux, a professor of psychology at George Mason University in Fairfax, Va. "There has been a gradual psychopathologizing of everyday problems in living."

The DSM-5, however, might escape such criticisms, Maddux conceded.

"Any movement towards a dimensional model is a move in the direction of being consistent with the research," he said. "Any change that reduces the probability that someone with a normal, expected problem in living is going to be said to have a mental disorder is also a move in the right direction."


SOURCES: James Maddux, Ph.D., professor, psychology, George Mason University, Fairfax, Va.; Feb. 9, 2010, teleconference with: Darrel A. Regier, M.D., vice chair, DSM-5 Task Force, and director, research, American Psychiatric Association; Charles P. O'Brien, M.D., Ph.D., chair, Substance-Related Disorders Work Group, and professor, psychiatry, University of Pennsylvania School of Medicine, Philadelphia; David Shaffer, M.D., member, Disorders in Childhood and Adolescence Work Group, and Irving Philips Professor of Child Psychiatry and professor of pediatrics, Columbia University, New York City; and B. Timothy Walsh, M.D., chair, Eating Disorders Work Group and W&J Ruane Professor of Pediatric Psychopharmacology (in Psychiatry), New York State Psychiatric Institute

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