Psychiatric Association Approves DSM-V

DSM-V psychiatry manual of mental disorders receives approval from APA

(RxWiki News) Mental health professionals use a standard reference book for diagnosing disorders. The American Psychiatric Association approved the major changes to the newest edition on Saturday.

The book is called the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current fourth edition has been used since 1994. Revisions to the DSM-V have been ongoing for over a decade.

At Saturday's meeting of the American Psychiatric Association, the APA Board of Trustees approved the categories of mental disorders the fifth edition will include.

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APA president Dilip Jeste, MD, said in the organization's Psychiatric News Alert that the approval of the DSM-V from the Board of Trustees is a "vote of confidence" for the new edition.

“We developed DSM-5 by utilizing the best experts in the field and extensive reviews of the scientific literature and original research, and we have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve,” Dr. Jeste said. Over 1,500 experts have weighed in on parts of the edition's revisions.

The number of disorders in the DSM-V is about the same as the number in the DSM-IV, but there are some substantial changes to the new edition besides cosmetic changes, such as modifications to the order of the chapters.

Four disorders have been removed from the edition: anxious depression, hypersexual disorder, parental alienation syndrome and sensory processing disorder.

Meanwhile, there are changes to the diagnostic criteria and definitions of four disorders in Section 3: attenuated psychosis syndrome, internet use gaming disorder, nonsuicidal self-injury and suicidal behavioral disorder. These conditions have either been added or else their criteria has been revised.

In Section 2 of the book, the DSM-V committee made changes in criteria or definitions to some personality disorders and specific learning disorders.

Among the more controversial changes is the removal of the "bereavement exclusion" under Major Depressive Disorder (MDD). This means that a person can now be diagnosed with major depression as soon as two weeks after the death of a loved one if they meet the other criteria for major depression.

Previously, individuals would not be diagnosed with MDD if the reason for their symptoms (such as sadness and difficulty sleeping, eating or concentrating) were related to the death of a loved one.

The DSM-V committee also adjusted the criteria or added conditions related to eight other disorders: autism spectrum disorder, binge eating disorder, disruptive mood dysregulation disorder, excoriation (skin-picking) disorder, hoarding disorder, pedophilic disorder, post traumatic stress disorder and substance use disorder.

“We have sought to be very conservative in our approach to revising DSM-5," said DSM-5 Task Force Chair David J. Kupfer, MD, in the Psychiatric News Alert. "Our work has been aimed at more accurately defining mental disorders that have a real impact on people’s lives, not expanding the scope of psychiatry.”

However, not all psychiatrists and experts agree. One of the most prominent critics of the changes to the DSM-V is Allen Frances, MD, the chair of the DSM-IV task force and now a professor emeritus at Duke University.

Calling the APA's approval of the DSM-V changes "the saddest moment" in the 45 years of his psychiatry career, Dr. Frances wrote in Psychology Today that the DSM-V is "deeply flawed" with changes that "seem clearly unsafe and scientifically unsound."

Dr. Frances's criticism, like many other critics of the new edition, centers on concerns about "medicalizing" normal aspects of being human and/or starting trends with some disorders.

"The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good," Dr. Frances wrote. "APA approval makes it likely that DSM 5 will start a half a dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society."

Dr. Frances outlined what he saw as the ten most potentially harmful changes to the DSM-V, primarily dealing with making it easier to diagnose individuals with certain disorders.

"New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs – often by primary care doctors after brief visits," Dr. Frances wrote. "Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs."

The DSM-V will published in May 2013.

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Review Date: 
December 3, 2012