May 17, 2013
Controversial New Psychiatry ‘Bible’ Unveiled
Brett Smith for redOrbit.com - Your Universe Online
Ushered in amidst a firestorm of controversy, the latest edition of the psychiatrist´s encyclopedia, known as the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, may already be out of date.
Released just this week, the DSM-5 will be used to determine official psychiatric diagnoses in everything from legislation, to courts of law, to insurance forms. However, its own authors admit that it is a “living document” and subject to change.
David Kupfer, the chairman of the task force charged with putting together the DSM-5, said the decision to break with past revisions and use an Arabic numeral ℠5´ instead the Roman numeral ℠V´ was meant to imply that the manual is not set in stone, a position applauded by critics of the new version.
"We used '5' because V.0 and V.1 just don't look good," Kupfer told Reuters.
With contributions from some of the biggest authorities in the field of psychiatry, the DSM-5 marks the first revision to the manual in almost 20 years.
Work began on this revision in 1999 with a greater emphasis on using scientific metrics as a basis for diagnoses instead of subjective observations. Some critics feel that the new revision did not fully embrace this new emphasis while others think it may have gone too far.
"We don't have blood tests or other objective criteria to distinguish mental sickness from health,” Gary Greenberg, a psychiatrist who conducted DSM-5 field trials, told Reuters. “So you have a set of criteria that are very common, which means the potential for many people being diagnosed as mentally ill when they're not."
The manual´s publisher, the American Psychiatric Association (APA), defends the new manual, saying that science has not yet progressed enough to make testing and metrics for mental disorders a reality.
"It would be great if we had been able to have a paradigmatic shift,” said Dr. Jeffrey Lieberman, president-elect of the APA. "The DSM can only reflect the research we have.”
Nevertheless, some of the changes found in the new manual could have a significant social impact. For example, it classifies uncontrollable gambling as an addiction, potentially making it easier for pathological gamblers to receive treatment that would be covered by their insurance policies.
Perhaps as a sign of the times, the new manual also makes compulsive hoarding its own diagnosis, now considered separate from obsessive-compulsive disorder. Because treatments for OCD are not always effective for hoarders, the authors decided to make the distinction, according to reports.
In a move criticized by some patient groups, the new manual is also expected to reduce diagnoses of autism spectrum disorders (ASD) by eliminating Asperger's syndrome and refining the ASD criteria.
“[C]hildren who were borderline cases under the previous DSM now won't get a diagnosis, which means they won't be eligible (for treatment),” said Katie Weisman, a spokesperson for the advocacy group Safe Minds.
Supporters of the new DSM emphasize that proper psychiatric treatment still relies heavily on the relationships between patients and doctors.
"We're trying to establish accurate and reliable guidelines, and you can't completely control how they're applied," Lieberman said. "The problem is not with the instrument but with the way it's used."