Psychiatrists to Revise Mental Illness Manual

For the first time in more than 15 years, psychiatrists plan to publish a completely new revised and updated edition of the Diagnostic and Statistical Manual of Mental Disorders — the nearly 1000-page tome that doctors rely on to classify, diagnose and treat mental illness.

The update will be the fifth iteration of a manual first published in 1952. It will likely have far-reaching consequences for doctors, patients, insurers and pharmaceutical companies, among others, affecting how people are diagnosed with mental illness and the drugs and therapies used to treat them.

“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but has not worked on the fifth, told the New York Times.

More than 500 experts have spent nearly 10 years reviewing the DSM-IV and coming up with the proposed changes, which are now listed on the association’s Web site.

Some of the changes are specific to certain disorders. For example, the new manual would eliminate the separate categories of autistic disorder and Asperger’s disorder, and classify them under a new, broader category of autism spectrum disorders — a term that’s already in everyday use.

Other changes are broader. For example, the manual would create a new category of “risk syndromes” that would aim to identify people with milder symptoms that indicate they could be at risk of later developing serious illnesses such as psychosis or dementia.

Other changes include:

• Creating a new childhood disorder called “temper dysregulation disorder” for children who are overly aggressive and tantrum-prone. Many children who are now diagnosed with bipolar disorder would likely receive the new TDD diagnosis instead.

• Creating a new category of “behavioral addictions,” which for the moment includes only gambling addiction. Working group members considered adding “Internet addiction” to the manual but decided there was not enough research evidence; instead they included it in an appendix.

• Adding a new eating disorder, “binge eating disorder,” which is regularly eating abnormally large amounts of food with a sense of loss of control and guilt. In a press release, the group says it is important to distinguish the new disorder from the common phenomenon of simply overeating.

Many of the proposed changes are controversial. Some psychiatrists, for example, feel that the new “risk syndromes” would encourage doctors to over-diagnose patients and over-medicate patients.

“There will be adolescents who are a little odd and have funny ideas, and this will label them as pre-psychotic,” Columbia University psychiatry professor Robert Spitzer, a critic of the DSM revision process, told the Washington Post.

Members of APA will be able to comment on the proposed changes until April 20, then a panel will begin to make revisions. The association expects to publish the final DSM-V in 2013.

On Wednesday’s NewsHour, Judy Woodruff talks to Dr. Alan Schatzberg, president of the American Psychiatric Association, and Dr. Allen Frances, former chief of psychiatry at the Duke University medical center, about the changes.