The Diagnostic and Statistical Manual of Mental Disorders (DSM) isn't just a guidebook for psychiatrists. It determines the drugs researchers pursue, how education money gets spent, which therapies insurance companies cover, and what kinds of behavior society views as "abnormal."
You have to expect such a momentous tome to face some controversy, but for the first time ever, the American Psychiatric Association committee behind the book is bowing to outside criticisms.
The committee had originally proposed that both "attenuated psychosis syndrome" and "mixed anxiety depressive disorder" join the DSM-5's list of mental illnesses. They announced Tuesday that neither diagnosis will make the cut.
"Attenuated psychosis syndrome" described youth at risk for schizophrenia, either due to having close family members with the disorder or having suggestive symptoms. Critics argued that only 8% of kids designated as "high risk" for schizophrenia eventually get diagnosed with the disorder. Making "pre-schizophrenia" a clinical syndrome would do more harm that good, DSM-5 committee opponents said, by promoting anti-psychotic prescriptions for kids who only have a slightly heightened chance of developing the disorder.
"Mixed anxiety depressive disorder" was judged an unnecessary duplication of depressive disorders that would also lead to more than necessary prescriptions.
A number of controversial changes to the DSM still remain on the table:
- DSM-5 will include bereavement in the definition of depression, meaning that someone emotionally mourning the loss of a loved one could fit under the diagnosis of major depression.
- Asperger’s syndrome loses its own diagnosis, it will be included under autism spectrum disorders. Critics argue that this will eliminate services particularly aimed at the unique Asperger's syndrome profile.
- "Substance abuse" and "substance dependence" will be combined into "substance use disorder." It's a less stigmatic name but one that could deter people who have substance problems, but don't feel dependent on substances, from seeking help.
It's interesting to me the amount of mental illness controversy that stems from pharmacological concerns. I wonder, would psychiatric diagnoses would be anywhere near as debated if they came without medication implications? There seems to be a steady give-and-take between adding more diagnoses to encourage treatment, and reining in diagnoses to prevent over-medication. Which puts patients at a greater risk?
The DSM-5 website has re-opened for comments, which will be accepted through June 15th 2012.
Photo: El Alvi/Flickr