January 1st, 2012

Changing times shape the real DSM-5

Considered the bible of psychiatric disorders, practitioners know the Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association, describes symptoms and criteria for diagnosing mental disorders and provides a valuable common vernacular for discussing diagnoses.

The DSM has been revised four times since its first printing in 1952 with a new iteration scheduled for May 2013. But according to the Psychiatric Association, the last 20 years have provided such an unparalleled spike in information about the brain and human behavior that the collective understanding of mental illness is greater than any point in history, making this edition pivotal.

“Some of the most compelling evidence contributing to the proposed additions to DSM-5 comes from neuroscience,” says David J. Kupfer, M.D., chair of the DSM-5 task force. “Throughout the 1990s – the ‘decade of the brain’ – important discoveries in genetics and epigenetics, brain imaging, neuroanatomy, pathophysiology and other areas of cognitive science, have shed light on our understanding of how mental disorders present and exist in relation to one another, as well as how best to identify and treat them.”

Since 2007, the DSM-5 Task Force and Work Group has been charged with evaluating recommendations for the deadline that is 16 months away. The DSM-5 Development Web site has chided the media’s reportage of alleged latest and greatest additions: Articles have speculated what will be added, like headline-grabbing sex addiction, and a result of Intermittent Explosive Disorder more commonly experienced as “road rage.”

In fact, more than 20 categories contain newly proposed additions. In several instances, conditions are simply moving from one category to another (i.e., it has been suggested that Agoraphobia become a diagnosis separate from the category “Panic Disorders”). In many cases, the criteria for diagnoses will change. There is even a proposed revision of the definition of a mental disorder.

“Work groups considered strongly whether (and in what ways) patients, their loved ones and clinicians would be affected by the inclusion of a particular new disorder,” says Kupfer, professor in the department of psychiatry at the University of Pittsburgh School of Medicine whose specialty is mood and sleep disorders.

“If it was determined that a clinical need was present, work groups turned to the scientific literature to assess the degree to which the phenomenon had already been studied and, based on these studies, what is known about the condition in terms of prevalence, symptoms, course, treatment and more.”

As this last year of research and revision begins before the grand unveiling, changing times, and a better understanding of community populations are just two things Kupfer says are shaping the revised DSM-5.

“Epidemiological findings from community populations informed our understanding of issues like diagnostic prevalence, disability and impairment and treatment-seeking,” he says. “Public health matters, like insurance coverage, access to services and consequences of inappropriate diagnosis and treatment, also played an important role in the development of DSM-5 proposals.”

By Jennifer E Chase

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