DSM ?

Recently we needed to move our Morningside Library to make room for two new staff.   On the plus side it was a good move because the material really needed to be gone through and purged of the out- of-date periodicals, books, and other material.  In the end we purged the Library down from three bookcases (16 shelves total) stuffed with obsolete items down to about 6 full shelves.  We decided we really didn’t need Safety Committee minutes and material from 13 years ago!  In the process we ran across old copies of the DSM (Diagnostic and Statistical Manual of Mental Disorders).  The DSM II and III, that were collecting dust on the bookshelf, were first published in 1968 and 1980 respectively.  We also have a couple of the fourth revised edition which came out in 2000.  So obviously this publication, put out by American Psychiatric Association, isn’t revised often.  Every 10-20 years seems like a long time to develop a new manual especially in this changing world of ours.  The next edition is scheduled to be published in May 2013 and, of course, it isn’t without some controversy.  I guess I would be up in arms if I thought they got it wrong and you had to wait a decade to see it corrected!

According to Michelle Diament writing for DisabilityScoop in an article entitled Psychiatrists Approve New DSM, Asperger’s Dropped she writes:

“However, officials did confirm that one of the most controversial proposals calling for autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified to be folded under the label “autism spectrum disorder” did get approved. The organization said the change will “help more accurately and consistently diagnose children with autism.”

Talk of the autism change has sparked concern that some currently diagnosed with the disorder may no longer qualify under the new criteria, but experts on the psychiatric association panel responsible for recommending the updates insist this will not be the case.

There is also concern about dropping the Bereavement Exclusion from Depression from this diagnostic publication.

In Jim Sabin’s Blog Health Care Organizational Ethics - For discussion and debate about the ethics of health care organizations and the wider health system he writes “In January I criticized the American Psychiatric Association (APA) for planning to drop the "bereavement exclusion" from the definition of major depressive disorder in the forthcoming new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Under the exclusion, the diagnosis of depression is not made if:

The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”

In a recent issue of the New England Journal of Medicine, Richard Friedman, a distinguished psychiatrist at Cornell who writes excellent New York Times columns for general readers, added to the voices criticizing the APA for medicalizing normal grief.  Here's the essence of Friedman's argument:

‘In removing the so-called bereavement exclusion, the DSM-5 would encourage clinicians to diagnose major depression in persons with normal bereavement after only 2 weeks of mild depressive symptoms. Unfortunately, the effect of this proposed change would be to medicalize normal grief and erroneously label healthy people with a psychiatric diagnosis. And it will no doubt be a boon to the pharmaceutical industry, because it will encourage unnecessary treatment with antidepressants and antipsychotics, both of which are increasingly used to treat depression and anxiety...The medical profession should normalize, not medicalize, grief.’

Despite criticism the DSM-V working group has not changed its plan to eliminate the bereavement exclusion, but it has added a footnote that at least acknowledges the challenge of distinguishing normal grief from the illness of depression.”

Well there you have it – two major controversies over the new publication.  They did come up with a new classification though 'Video Game Addiction'.  Hum I wonder what psychotropic drug will be developed to counteract this (I am sure the pharmaceutical manufacturers are wringing their hands in glee over this).   I am not sure how my son will react when I tell him he has a certified mental illness but not to worry because Pfizer will soon have a pill to help!