Rules for diagnosing mental disorders are to be
changed
An
update to one of the most important manuals in mental health - known as the
bible of psychiatry - has been unveiled.
Controversy
and criticism has surrounded work on the fifth version of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5).
Critics say the rulebook turns normal behaviour, like grief or childhood temper tantrums, into mental illness.
It
is used mainly in the US, but is influential around the world.
This
is the first update to the volume since 1994. Experts in mental health have
been taking account of the latest scientific developments to update ways of
diagnosing mental disorders.
The
changes were presented at a meeting of the American Psychiatric Association
(APA).
There
are new categories including binge eating disorder, disruptive mood
dysregulation disorder (previously known as childhood bipolar disorder) and
hoarding disorder.
Meanwhile
Asperger's syndrome is one of four previously separate conditions that have now
become part of a single condition called autism spectrum disorder (ASD).
ASD
now encompasses autism as known previously, Asperger's disorder, childhood
disintegrative disorder, and pervasive developmental disorder which has not
been specified.
The
main symptoms of ASD are deficits in social communication and social
interaction and restricted repetitive behaviours, interests, and activities.
The
publication will have no effect on how people are diagnosed in the UK and other
countries which use guidelines from the World Health Organization.
Attention
deficit hyperactivity disorder (ADHD) has been modified to emphasise that this
disorder can continue into adulthood.
Making normal ill
Ahead
of the update, Prof Peter Kinderman, head of the Institute of Psychology at the
University of Liverpool, argued
on the BBC's Scrubbing Up column that: "[DSM-5] will lower many
diagnostic thresholds and increase the number of people in the general population
seen as having a mental illness."
He
said "normal grief" would now be classed as a major depressive
disorder and childhood temper tantrums would be a symptom of disruptive mood
dysregulation disorder.
Also:
"A wide range of unfortunate human behaviours, the subject of many new
year's resolutions, will become mental illnesses - excessive eating will become
'binge eating disorder', and the category of 'behavioural addictions' will
widen significantly to include such 'disorders' as 'internet addiction' and
'sex addiction'."
Genes
There
is also criticism of the way DSM-5 classifies diseases based on symptoms. There
are efforts to harness advances in genetics and neuroscience to diagnose people
based on the cause rather than the symptoms of the illness.
The
director of the US government's National Institute of Mental Health said the
DSM had a "lack of validity".
Dr
Thomas Insel posted a blog saying: "Unlike our
definitions of ischemic heart disease, lymphoma, or Aids, the DSM diagnoses are
based on a consensus about clusters of clinical symptoms, not any objective
laboratory measure.
"In
the rest of medicine, this would be equivalent to creating diagnostic systems
based on the nature of chest pain or the quality of fever."
In
some areas the distinction between disorders is narrowing. Autism, attention
deficit-hyperactivity disorder, bipolar disorder, major depressive disorder and
schizophrenia are all classed as separate disorders based on their symptoms.
However,
research published in the Lancet medical journal in February showed all five
disorders shared several genetic risk factors.
Dr
David Kupfer, the chair of the DSM-5 task force, said: "The changes to the
manual will help clinicians more precisely identify mental disorders and
improve diagnosis while maintaining the continuity of care.
"We
expect these changes to help clinicians better serve patients and to deepen our
understanding of these disorders based on new research."
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