DSM-5 New DSM Edition Sparks Controversy in Some Areas

DSM-5 New DSM Edition Sparks Controversy in Some Areas Basics Print Diagnostic and Statistical Manual of Mental Disorders The latest edition of the DSM makes some controversial changes By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on October 09, 2019 BraunS/Getty Images More in Psychology Basics Psychotherapy Student Resources History and Biographies Theories Phobias Emotions Sleep and Dreaming The long-awaited new edition of the Diagnostic and Statistical Manual of Mental Disordersâ€"DSM-5 for shortâ€"angered some mental health professionals and patient advocates, both for what it included and didnt include, when it was released by the American Psychiatric Association in May 2013. For years, the DSM has been known as the psychiatrists bible. It affects more than just the diagnosis of mental illnessâ€"its used in determining insurance benefits and disability, affects the availability of special education and social services, and is a staple in court proceedings. This latest edition, the fifth, had been several years in the makingâ€"years that saw extreme controversy about some of the proposed changes. Some members of the committees working on the new volume even resigned in protest of particular changes. DSM-5 as a Diagnostic Tool The DSM lists criteria for diagnosing such things as psychotic disorders (like schizophrenia), mood disorders (like bipolar), anxiety disorders, personality disorders (like antisocial personality disorder), trauma- and stressor-related disorders (such as PTSD), and many, many more. For each disorder, theres a list of specific symptoms and behaviors that must or must not be present in order for the illness to be diagnosed. Usually, a certain number of the listed items must be present, rather than all of them. For example, in bipolar disorder, in addition to the mood disturbance, three to four of these seven symptoms or behaviors have to be present in order to diagnose the condition: Inflated self-esteem or grandiosityDecreased need for sleepMore talkative than usual, or pressured speechEasily distractedIncrease in goal-directed activityExcessive involvement in risky activities DSM-5 Controversies: Autism, ODD, Bipolar There was a big public outcry when four separate autistic disorders that had been listed in the fourth edition of the DSM, including Aspergers Syndrome, were combined into a single illness, Autism Spectrum Disorder, for the DSM-5. Patients currently diagnosed with Aspergers and their parents feared losing social and educational services. However, its not clear if this has occurred since the change in the DSM was made. Others in the mental health community were bitterly opposed to including an illness that was in the previous version, Oppositional Defiant Disorder (ODD). The diagnosis involves children and teens who talk back to parents and teachers, who sometimes refuse to obey authority figures, and who lose their tempers easily, labels that child or teen mentally ill unnecessarily. What was not added was a diagnosis for pediatric bipolar disorder (also called child-onset bipolar disorder, or COBPD). Instead, a new diagnosis was created called Disruptive Mood Dysregulation Disorder (DMDD). This disorder focuses on frequent, severe temper outbursts and overall irritability or anger between them. Disruptive Mood Dysregulation Disorder can be diagnosed along with Major Depressive Disorder (MDD), but not with bipolar disorder. If you look at the symptoms of bipolar disorder in children, as combined by childhood bipolar experts Demitri Papolos, MD, and his wife Janice Papolos, you will see some similarities and some differences between these and those of a child diagnosed with both DMDD and MDD. National Institute of Mental Health (NIMH) Response National Institute of Mental Health Director Dr. Thomas Insel didnt appear to like the DSM-5s approach, at least initiallyâ€"he said as the DSM-5 was released in 2013 that going forward, NIMH will be re-orienting its research away from DSM categories, with the objective of developing a system that includes genetics, biomarkers, brain scans and other physical aspects of and testing for mental illnesses. Insel wrote, While DSM has been described as a Bible for the field, it is, at best, a dictionary, creating a set of labels and defining each. Criticizing the validity of the DSM, Insel appeared to some to be withdrawing all support for the DSM-5. However, just two weeks later a press release issued by NIHM and written jointly by Insel and Jeffrey A. Lieberman, M.D., President-elect, APA, clarified Insels earlier blog post. In particular, the press release says: Today, the American Psychiatric Associations (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD), represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. However, NIMH still has plans to go forward with developing a more physically based diagnostic system, although the agency acknowledges that this is a long-term project. Future research in the field will need to be based on dimensions of observable behavior and neurobiological measures in order to qualify for NIMH grant funding.