May 3, 2012 | 2
I have this slim silver book on my desk called the “Quick Reference to the Diagnostic Criteria From DSM-IV-TR.” Page 153 reads:
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
(3) disorganized speech (e.g., frequent derailment or incoherence)
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or avolition
Throughout the book, similarly organized lists of symptoms follow the names of every officially recognized mental disorder—bipolar disorder, autistic disorder, generalized anxiety disorder and so on. My slim silver volume is an abridged version of the Diagnostic and Statistical Manual for Mental Disorders IV-TR (DSM-IV-TR), the most current edition of the standard reference guide for psychiatrists. It’s the book that many psychiatrists consult when deciding what ails their patients.
For the past 11 years, the American Psychiatric Association (APA), which publishes the DSM, has been working on a brand new version of the manual, the DSM-5 (no more Roman numerals, now that we have fully entered the age of digital publishing). Psychiatry’s new “bible” is slated for publication in May, 2013.
The APA has overhauled the DSM several times in the past—always a laborious and controversial process. This time, the association is doing things a little differently. Psychiatrists within and outside the APA have long criticized the revision process for its opacity. So the APA has made drafts of the new DSM-5 available on their website for public comment and has amended the drafts based on feedback from the psychiatrists, psychologists and the general public.
The latest drafts of the DSM-5 are now available online and open to comment for the next six weeks. Here are the most significant updates:
-The APA is no longer considering “Attenuated Psychosis Syndrome” as a new official disorder in the DSM-5. The proposed diagnosis was supposed to help identify children at risk for developing a psychotic disorder, but research has shown that 2/3 of children who qualify as “at risk” never progress to true psychosis.
-The APA is no longer considering “Mixed Anxiety Depressive Disorder” as a new official disorder in the DSM-5. Many psychiatrists worried that the new diagnosis was too vague and that too many people would qualify.
-The APA has added a footnote to the Major Depressive Disorder criteria “to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder.” Previous changes to the depression criteria reframed grief that lasted longer than 2 months as a sign of depression, even if someone had recently lost a loved one—a mistake that drew intense criticism.
This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!