Hot off the press, the fifth edition of the American Psychiatric Association’s DSM-V (Diagnostic and Statistical Manual), is one of the most controversial books to be published this year.
The DSM, often called the “bible of mental-health care,” attempts to identify nearly every variation in human behavior to allow for standardized health diagnoses.
Mental-health professionals use the DSM’s specific diagnoses to identify and treat psychiatric conditions. Standardized diagnostic categories allow providers to employ a common language when communicating on behalf of their patients. DSM diagnostic standards are also used for government policies, grant funding and insurance reimbursement.
While mental-health professionals primarily use the DSM behind the scenes, its very existence impacts those seeking mental-health care in this country. Patients may not even be aware that the book exists, despite the fact that it impacts their care, insurance coverage and reimbursement.
However, critics of the new edition abound. In May, officials at the National Institutes of Mental Health, the world’s largest funding agency for mental-health research, announced that they would no longer fund projects that rely exclusively on the DSM. Their primary complaint is that the manual lacks validity because it classifies disorders solely based on symptoms.
Despite the criticism, there is also praise. The DSM-V promises to be an influential and important document in mental-health care.
Changes to DSM-V
The new edition includes a number of significant changes. Among the most controversial are changes in the areas of autism and substance abuse. Basic terminology also has changed. For instance, the diagnosis of “mental retardation” has been replaced by “intellectual disability,” bringing DSM-V in line with current standards of practice by eliminating a politically incorrect term.
Of particular interest to parents may be the changes involving autism, a diagnosis that, according to the New York Times, is received by one in every 88 children today. In earlier editions, there were four previously separate diagnoses related to autism – autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive development disorder. Now, autism is defined by a “sliding scale” of symptoms, under the umbrella of “autistic spectrum disorders.”
This concept is consistent with current understanding of autism being a condition that manifests in a range of severity. There is some concern, however, that the new classification may end up disallowing a diagnosis for some children with mild symptoms, children who may have been previously diagnosed with Asperger’s or Pervasive Developmental Disorder. These children could end up losing special education services they receive at school, among other things.
One alternative may be “social communication disorder,” a new designation for children who have communication difficulties without other hallmarks of autistic spectrum disorder.
The earlier DSM chapter on substance abuse is now called “substance abuse disorders.” Changes in the substance abuse category are organized similarly to those in autistic spectrum disorders, where diagnoses are categorized based on symptom severity.
The term “addiction” is in and “dependence” is out. Gambling addiction and cannabis withdrawal are new diagnoses in this section, as are caffeine withdrawal and intoxication.
Mental-health professionals, consumer groups and advocates of all stripes will continue to debate the merits of the new DSM-V.
The good news is that effective mental-health care is available, including medical treatment, psychotherapy, counseling, support groups and behavioral approaches. The wise patient should be aware of the DSM-V and its potential implications, while pursuing treatment and evaluating the evidence that relates to their personal situation.
The new DSM-V can be found at Stanford Health Library.
The main branch of Stanford Health Library is located at the Hoover Pavilion, 211 Quarry Road, Suite 201, Stanford. Hours are 9 a.m. to 5 p.m. Mondays through Fridays.