Psychiatric Bible Open to Public Comments

(AP)  Don't say "mental retardation" - the new term is "intellectual disability." No more diagnoses of Asperger's syndrome - call it a mild version of autism instead. And while "behavioral addictions" will be new to doctors' dictionaries, "Internet addiction" didn't make the cut.

The American Psychiatric Association is proposing major changes Wednesday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them.

The manual suggests some new diagnoses. Gambling so far is the lone identified behavioral addiction, but in the new category of learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don't purge.

Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders - such as dementia or schizophrenia - based on early symptoms, even though there's no way to know who will worsen into full-blown illness. It's a category the psychiatrist group's own leaders say must be used with caution, as scientists don't yet have treatments to lower that risk but also don't want to miss people on the cusp of needing care.

Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

But overall the manual's biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses - and urge doctors to concentrate more on the severity of their patients' symptoms. Thus the draft sets "autism spectrum disorders" as the diagnosis that encompasses a full range of autistic brain conditions - from mild social impairment to more severe autism's lack of eye contact, repetitive behavior and poor communication - instead of differentiating between the terms autism, Asperger's or "pervasive developmental disorder," as doctors do today.

"Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)" Development (APA)

The psychiatric group expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.

"Is someone really a patient, or just meets some criteria like trouble sleeping?" APA President Dr. Alan Schatzberg, a Stanford University psychiatry professor, told The Associated Press. "It's really important for us as a field to try not to overdiagnose."

Psychiatry has been accused of overdiagnosis in recent years as prescriptions for antidepressants, stimulants and other medications have soared. So the update of this manual called the DSM-5 - the "Diagnostic and Statistical Manual of Mental Disorders," fifth edition - has been anxiously awaited. It's the first update since 1994, and brain research during that time period has soared. That work is key to give scientists new insight into mental disorders with underlying causes that often are a mystery and that cannot be diagnosed with, say, a blood test or X-ray.

"The field is still trying to organize valid diagnostic categories. It's honest to re-look at what the science says and doesn't say periodically," said Ken Duckworth, medical director for the National Alliance for the Mentally Ill, which was gearing up to evaluate the draft.

The draft manual, posted at www.nami.org, is up for public debate through April, and it's expected to be lively. Among the autism community especially, terminology is considered key to describing a set of poorly understood conditions. People with Asperger's syndrome, for instance, tend to function poorly socially but be high-achieving academically and verbally, while verbal problems are often a feature of other forms of autism.

"It's really important to recognize that diagnostic labels very much can be a part of one's identity," said Geri Dawson of the advocacy group Autism Speaks, which plans to take no stand on the autism revisions. "People will have an emotional reaction to this."

Liane Holliday Willey, an author of books about Asperger's who also has the condition, said in an e-mail that school autism services often are geared to help lower-functioning children.

"I cannot fathom how anyone could even imagine they are one and the same," she wrote. "If I had put my daughter who has a high IQ and solid verbal skills in the autism program, her self-esteem, intelligence and academic progress would have shut down."

Terminology also reflects cultural sensitivities. Most patient-advocacy groups already have adopted the term "intellectual disability" in place of "mental retardation." Just this month, the White House chief of staff, Rahm Emanuel, drew criticism from former GOP vice presidential nominee Sarah Palin and others for using the word "retarded" to describe some activists whose tactics he questioned. He later apologized.


For more info:
APA Announces Draft Diagnostic Criteria for DSM-5 (APA Press Release, 2.10.10)
The Stories Behind Sex Addiction ("Sunday Morning," 1.24.10)
Unraveling the Secrets of "Alters" ("Sunday Morning," 3.08.09)
Bipolar Disorder Overdiagnosed? (WebMD, 5.06.08)
Obsessive Gaming Not A Disorder, Yet (6.27.07)
By AP Medical Writer Lauran Neergard; AP Medical Writer Lindsey Tanner in Chicago contributed to this report

[kenhamlett]

Get real. This book might as well have been written by Dr. Seuss.

There is no science backing this assembly of opinions. In fact the money devoted to what should be scientific research is squandered on do nothing projects, leading to requests for more money. As for the so called profession, it has no basis in fact at all. Face it,a band of con artists and sociopaths got together to assemble a group of labels they use to claim someone is inferior to them with the expectation of getting paid for their interference in the lives of other people.
Thus this book is simply a documentary of hypocrisy and deception. If you doubt it, ask for a list of cures (not treatments) for each mythical condition.

[bobnjersey]

[As for the so called profession, it has no basis in fact at all. Face it,a band of con artists and sociopaths got together to assemble a group of labels they use to claim someone is inferior to them. Thus this book is simply a documentary of hypocrisy and deception. If you doubt it, ask for a list of cures (not treatments) for each mythical condition.]

nearly every one of these conditions have their root in brain chemistry ... and the effectiveness of many of the treatments (pharmacological) proves it.

just because you don't know everything about what makes something what it is ... doesn't mean it isn't.

[kenhamlett]

Wait a minute Bob.
A spoon of sugar affects brain chemistry also. So what? The chemistry of the body should be under the domain of an endocrinologist, not a shrink. They don't have the answers either but at least they have a chance of finding the root causes. As for the drugs you use, they simply cover up symptoms with other symptoms, masking the problem and endangering the health and very life of the person taking them. They do nothing to cure anything and there are two alternatives in using them. They either keep the person poisoned until the body straightens out its own chemestry or they make the person dependent on them, often for life because the body can no longer function without the drug.
Take the popular doubletalk about Autism. You can't cure it but you want to make a buck anyway so you claim to have "treatments". You have done nothing of value and the definition in the book in question is so broad regarding of Autism that it is meaningless. It is a con.

When you try to use the old brain chemistry argument be sure I am not one of the readers. I know the claims and I know it is a topic far beyond the abilities of your profession. All psychiatry does is drug em and bilk em. The sophistry used to explain the conditions is just part of the con.

[cidaia]

I'm waiting for doctors to open the book and let us laypeople have input into how and when to diagnose malaria.

Let's have a vote on whether someone really has malaria!

[cowardlyimbecile]

And from now on Sarah Palin is no longer retarded, she's the Queen of the Rocking 'R' Ranch. yee yah!

[sandy19731]

As a member of the profession I wish laypeople would quit referring to the DSM as a "bible" it is nothing of the sort.

We only have one version at a time which is based on the lastest scientific research. Obviously, not a bible.

[cidaia]

I don't consider a vote "scientific research".

Why don't you admit there's a difference between diagnosing someone based on (OBJECTIVE!) medical-biological symptoms, vs. diagnosing someone based on (SUBJECTIVE!) deviance from an idealized standard of what constitutes normal-acceptable behavior?

The only diseases that should be in the DSM are those diseases which have had their BIOLOGICAL causes tracked down - that are diagnosed via legitimately scientific means, such as brain scan, chemical testing, etc.

Any other disease should not be viewed as "medical", and the people who diagnose them should not be viewed as "doctors" - a prestigious title they are not worthy of.

They should be called what they are - priests of the religion humanism, applying its essentially religious (at the very least ideological) views about what constitutes normalcy & ideal behavior.

[bobnjersey]

[The only diseases that should be in the DSM are those diseases which have had their BIOLOGICAL causes tracked down - that are diagnosed via legitimately scientific means, such as brain scan, chemical testing, etc.]

if a tree falls in the woods ... and there's nobody there ... does it make a sound?

historically ... and before there existed the appropriate technology ... did the whole range of electromagnetic energy exist ... even though the inherent human senses and central nervous system (eyes, ears, nose, tactile) could not measure them directly?

[and the people who diagnose them should not be viewed as "doctors" - a prestigious title they are not worthy of.]

there was a time ... not too long ago ... where 'doctors' would treat current common ailments by draining the patient's blood. these same 'doctors' bathe cancer patients in radiation to kill a single tumor.