Diagnostic and Statistical Manual V: Small Changes with Big Implications

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What will be the implications of the DSM-V? Image by Digital Shotgun

The Diagnostic and Statistical Manual, or DSM, is being updated again.

The American Psychiatric Association’s timeline calls for the “Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc..” in December of 2012.

This edition, the fifth, attempts to further define what is, and what is not, a mental disorder.

What symptoms are included, what they are named, and who will escape labeling all become problematic… and political.

While the addition of binge eating appears to be somewhat neutral, and perhaps overdue, and the folding of Asperger’s syndrome into the autism spectrum may be based purely on brain science, other proposed changes are more nuanced.

Dependence to Become Addiction?

According to Recovery Today Online, one major anticipated change in the new DSM-V will eliminate the category of “substance abuse and dependence” and replace it with “addictions and related disorders.”   While the difference may seem semantic, the intent is to clarify that withdrawal is a normal response to the discontinuance of some medications, “whereas addiction is compulsive-drug seeking behavior.”  The emphasis would now be on the behavior, rather than the physical response.

Ironically, in a year when marijuana use has gained new legal acceptance, new criteria is suggested for cannabis withdrawal. 

Gender Identity Disorder to Become Gender Dysphoria?

In what could be seen as a political move, the DSM-V is expected to focus more on the unhappiness that gender identity problems may cause rather than the issue of gender identity itself.  Everyday Health notes that it is problematic if psychiatry “casts one’s identity as an illness.”  Focusing on emotional, rather than a state of being, appears to address this issue.

Women will be affected by the proposed changes. Image by thisreidwrites

Implications for Women

Some of the proposed changes have a disproportionate impact on women.  Men would be unlikely to be diagnosed with the newly proposed “premenstrual dysphoric disorder.” As with gender dysphoria, the intent appears to be to focus on the emotions associated with PMS rather than menstruation itself.

Proposed upgrades to the personality disorders category are heartening.  Women were frequently diagnosed as “histrionic” a personality disorder that is slated for deletion.  The “disorder” included many criteria such as shallow relationships, focus on self, over dramatization and seductiveness.

Additional Proposed Disorders for the DSM-V

Hoarding and binge eating have been on the scene for a while.  Originally considered a type of OCD (obsessive-compulsive disorder) hoarding is understood to have distinct features. Binge eating, once only in the appendix of the DSM-IV will most likely be added to same category as anorexia.  Children will no longer be bi-polar, but could instead be categorized as having “disruptive mood regulation disorder” to distinguish their issues from adult bi-polar disorder, which may keep children from being mislabeled and potentially, inappropriately medicated.  Other changes, such as the elimination of “metal retardation” in favor of “intellectual developmental disorder” appear to be kinder and gentler.

Changes in Mental Disorder Labeling

At the end of the month, the final version will be submitted for printing in May of 2013.  Women, children, the intellectually challenged, and those who identify with both genders appear to be poised to be the winners of this round.

Sources:

Curley, B. DSM-V-Major Changes to Addictive Disease Classifications: Recovery Online Today. (2012). Accessed December 1, 2012.

American Psychiatric Association. DSM-V Development–Timeline(2012). Accessed December 1, 2012.

Hiss, K. 14 Big Changes in ‘The Psychiatrist’s Bible’: Everyday Health(2012) Accessed December 1, 2012.

Healthy Place. Histrionic Personality Disorder(2012). Accessed December 1, 2012.

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© Copyright 2012 Gina Putt, All rights Reserved. Written For: Decoded Science

Comments

  1. Gina PuttGina Putt says

    Regula,
    Having worked for a mental health agency, I tend to agree in general that psychotropic drugs are overused. I also have held elementary teaching certificates and do indeed understand that the family is often the genesis of a child’s behavior problems. All that being said, I still feel that avoiding the label of bi-polar disorder is a coup for children in general. Unfortunately, our health system often has few resources available to families that could benefit from counseling. I think saying that all psychotropic drugs reduce individuals to “mental retardation” is quite an overstatement, however. Many people have been helped by pharmacologic assistance in regulating their depression, anxiety and obsessive behaviors. The goal may be to eventually learn better coping skills, but often, the distress is great enough that a more immediate intervention is helpful. Thank you for your comments on this article!

  2. Regula says

    When you label and treat children for disruptive behavior, tantrums etc. then you really don’t see the connections right. The ones who need treatment are often the parents. The children are only a reflection of what the parents hit down on them or deprive them of. While in some extreme cases the name of a disorder come automatic, there is a real danger that minor problems, which could have been cured with a little bit of gentleness and patience for both, the parents and the children, get labeled as a mental disorder, i.e. the equivalent of a physical illness, that should be treated with drugs. But drugs seldom cure or genuinely alleviate any emotional problem. Unfortunately, the vast majority of psychotropic drugs add abuse to injury: they don’t alleviate anything, they hit a person down until that person cannot act out anymore. Because the person then shuts up, it is considered a cure. But that isn’t the case. The pills facilitate taking care of difficult patients at the cost of reducing the patient to mental retardation. Under the influence of psychotropic drugs, a person cannot feel the atmosphere in a book, film etc. and cannot connect intuitive understanding – i.e. instinct – with intellect. That is the epitomy of retardation.

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