The Mental Health Minute

Articles and news about mental health issues

Shifts Ahead for Mental Diagnoses

DSM-IV-TR, the current DSM edition
Image via Wikipedia

Here’s just one of the myriad of articles today about the revision of the DSM.  I am really happy to see that a revision is transpiring, because I have always felt that the last revision was way too broad in scope and effectively “watered-down” some of the significant diagnoses.

For those of us working in mental health, we realize what a big deal this revision will be.  For one thing, this is the bible used by the insurance companies in their determination of payment.  So, if your diagnosis is not in this book, it will not be covered for treatment.  While categorizing different illnesses makes life easier for payors, it is not necessarily what the patients need.  Labeling is always harmful and dangerous.   As this article states, people can become “attached” to a label in a not too positive way.

Please won’t you leave a comment about your feelings regarding this revision?  Let’s start a conversation.

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Experts Call for Field’s ‘Bible’ to Recognize Hoarding; ‘Net Addiction a Maybe

By SHIRLEY S. WANG

Mental-health experts wrestling with how to fit temper tantrums, hoarding and even Internet addiction into the current understanding of mental illness are proposing changes to the field’s primary reference for diagnoses for the first time in 16 years.

The draft revisions of the Diagnostic and Statistical Manual of Mental Disorders—the bible for mental health clinicians and researchers—unveiled Wednesday could have effects that ripple through mental health care.

Researchers, clinicians and insurance companies use the DSM to make diagnostic, treatment and coverage decisions. For drug companies, changes could open up opportunities for new drugs or expand the uses of existing ones. And for patients, inclusion of their disorder serves to legitimize their condition as well as potentially paving the way for new treatments.

The draft revisions, announced Wednesday, are open for public comment until April. Field trials then will be conducted to study whether the new diagnoses make sense and are useful to clinicians, including social workers, psychologists and psychiatrists. The final version, after further changes, will be published in 2013.

One new diagnosis: hoarding, where people have significant difficulty discarding personal possessions. Hoarding can lead to significant distress, and including it in the DSM is expected to increase public awareness and stimulate diagnosis and research into the disorder. Another diagnosis recommended for inclusion is “temper dysregulation disorder with dysphoria” for children with severe tantrums and irritability.

The revisions would drop Asperger’s disorder, which is characterized by difficulties with social interactions and repetitive behaviors, as a separate diagnosis. It would be subsumed into a broader category of autism spectrum disorders. The draft also overhauls the family of substance-use disorders and cuts subcategories of schizophrenia.

A number of conditions proposed by international experts and consumer advocates are still being considered. These conditions include “apathy syndrome,” in which people suffer from a severe lack of motivation, “seasonal affective disorder” and Internet addiction.

The latest overhaul of the manual, its fifth, isn’t expected to increase the overall number of diagnoses, which is about 300. It is “trying to capture more central themes” about what defines a disorder, rather than parsing conditions into more diagnoses, said David Kupfer, chairman of the task force convened by the American Psychiatric Association to coordinate the revisions.

Deciding just what constitutes distinct mental illness has long been an issue in mental health care. “A great deal of research has gone into validating the current diagnostic system,” said John Krystal, deputy chairman for research in the department of psychiatry at Yale University, who isn’t involved in the task force. “But it is far from optimal.”

“The greatest challenges that we face is that the patients that we group together within a single psychiatric diagnosis are quite heterogeneous,” said Dr. Krystal.

A new diagnosis, “mixed anxiety depression,” is proposed because many patients experience significant symptoms from both depression and anxiety. Currently, patients can be diagnosed with both disorders, but those patients haven’t been studied systematically, nor has the Food and Drug Administration approved treatments specifically for them, said Darrel Regier, vice chairman of the DSM revision task force. “You can’t imply that a person with major depression is going to respond in the same way if they have a significant anxiety component or if they don’t.”

The category of substance abuse and dependence disorders is being broadened to include nonsubstance issues, such as gambling addiction. Also, the renamed category, called “addictive behaviors,” will be limited to people who go to great lengths to obtain a substance or behavior and who have extreme cravings for it.

Excluded under the changes would be people who are simply physiologically dependent, which means they need to take a higher and higher dose of a prescribed medication to get the same effect or suffer withdrawal symptoms when they stop.

With autism and Asperger’s disorder, there isn’t enough evidence to justify keeping current separate diagnoses, said Dr. Regier. One in 110 children is now diagnosed with autism-spectrum diagnoses, according to the Centers for Disease Control and Prevention.

The draft criteria propose that autism-spectrum disorders be viewed on a continuum of characteristics behaviors rather than distinct diagnoses.

Getting rid of Asperger’s may provoke an outcry from individuals who have formed an identity and community around the diagnosis, said Dr. Regier.

You can go here for the original article.

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February 10, 2010 - Posted by | Mental Health | , , , , ,

2 Comments »

  1. I like how your blog is laid out. I have bookmark this and look forward to see more. Thanks.

    Comment by flash | February 10, 2010 | Reply

  2. It’s more important for people to be aware of the FRAUD and deception that has infiltrated the autism community. As in Ari Ne’eman, who is Aspergers( diagnosed in 2000 not as a child of course), and switches back and forth between the terms, as if interchangable. Then there’s the notorious Amanda Baggs (google amanda baggs controversy), a woman who took copious amounts of LSD and suffers with “factitious disorder” or “psychogenic autism”. Would make a nice TV movie of the week, actually. Then you have an old time pro at posing as autistic: the ever popular bless her heart, who really does believe she is autistic: Donna Williams, who herself admits in her book, “nobody nowhere,” she had a multiple personality disorder. So, she’s not autistic either so say many experts. Apparently, this hasn’t hit the American Psychiatry seminars, as they are totally oblivous to the factitious disorder epidemic inside the autism community. You’d think they’d get it, being shrinks and all, but I guess they forgot about groupthink, mass hysteria, etc…and that Hollywood has given all sorts of mentally imbalanced folks who need attention, a deep desire to cling to the autism diagnosis so they can get into newspapers and on CNN to tell their fake autism story. This is truly funny. It should be on the Saturday Night Live specials..everyone and their grandma now is autistic. Like it’s popular. Fun. Jump on board. Let’s ride the autism train. If you were really dealing with autism you would never ever be thinking about autism pride or activist movements. Get real. Get some Haldol

    Comment by sanjoseaspie | February 23, 2010 | Reply


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