Changes to psychiatrists’ diagnostic ‘bible’ hinted at

PsychCentral reports on the likely changes to appear in the DSM-V, the new version of the psychiatrist’s diagnostic manual, due out in 2012 and discussed in a recent presentation in last week’s American Psychiatric Association annual conference.

The most significant change proposed has to do with the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across many major mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner.

Despite the PR spin that “no limits” were placed on this revision of the DSM, the reality is that there will be very few significant changes from the existing edition of the DSM-IV. While virtually all disorders will be revised, the revisions will, for the most part, be incremental and small. Why? Because the APA recognizes that you can’t retrain 300,000 mental health professionals (not to mention the 500,000 general physicians) in the field to completely relearn their way of diagnosing common mental disorders such as depression, bipolar disorder, ADHD and schizophrenia. Changes are always incremental and tweak the existing system, nothing more.

The inclusion of dimensional ratings owes much to the role of psychometrics in the assessment of mental illness, but it remains to be seen how extensively this is implemented as it could just be a fancy label for sub-categories of degree (slight, moderate, severe etc) rather than the reliance on statistically sound measurements.

The post also mentions that there may be some moving of the diagnostic furniture with some additions and retractions but no major shakeups.

There’s more coverage on MedPage, but bear in mind that as we’re still three years away from publication so it’s worth bearing in mind that some of the final decisions have still to be made.

Link to PsychCentral post ‘Update: DSM-V Major Changes’.
Link to MedPage coverage.

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