The DSM-5 has been finalised

It’s arcane, contradictory and talks about invisible entities which no-one can really prove. Yes folks, the new psychiatric bible has been finalised.

The American Psychiatric Association have just announced that the new diagnostic manual, to be officially published in May 2013, has been approved by the board of trustees.

You can read the official announcement and a summary of the major changes online as a pdf – and it seems a few big developments are due.

The various autism-related disorders have been replaced by a single ‘autism spectrum disorder’ – essentially removing Asperger’s from the manual.

A ‘disruptive mood dysregulation disorder’ has been added to “diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year”.

As the APA admit, this is largely to address the rise of the ‘childhood bipolar disorder’ concept which has led to a huge number of children with challenging behaviour being medicated on rather ill-defined grounds. Whether this actually does anything to change this, is another matter.

Despite the expected revision of the overly complex and often indistinguishable subtypes of personality disorder – these have been kept as they were.

Posttraumatic stress disorder has been tinkered with – apparently to pay “more attention to the behavioral symptoms” and presumably to exclude ‘PTSD after seeing things on the TV’ – a change included in all the drafts.

Perhaps most controversially, the bereavement exclusion will be removed from the diagnosis of depression – meaning you could be diagnosed and treated for depression just two weeks after a loss if you fulfil the diagnostic criteria.

If you want to examine the changes yourself – tough luck – the APA have removed all the proposed criteria off the DSM-5 website. This is supposedly to “avoid confusion” but most likely because the manual is a big money-maker and the finished product will be on sale in May 2013.

But diagnostic developments aside, we can also expect some changes simply from the benefit of hindsight.

Most clinicians will learn enough of the new manual to ensure they look cutting-edge for a few months after publication and then ignore the new diagnoses and use the same ones they’ve always had vaguely stored in their heads.

Researchers will go through an extended period of academic willy waving where they attempt to outdo each other through their wide and extensive knowledge of dull and irrelevant details.

Drug companies will wet themselves in delight at the new opportunities for drug marketing (“Prozac – lighten the mood of losing your mother”).

The APA will keep underlining how we’re now in a new era of science thanks to the science behind the new manual of science that turns everything it touches into pure, definitely not insecure, science.

And finally, the chairman of the DSM-5 committee will begin the traditional process of becoming disillusioned and publicly denouncing each step in the development of the DSM-6.

It’ll be as if the past never happened.

pdf of APA announcement of finalised DSM-5 (via @sarcastic_f)
Link to APA announcement in Psychiatric News.

11 thoughts on “The DSM-5 has been finalised”

    1. Perrsonality disorders still exist but it will take a full year of documenting symptoms and behaviors before the person can actually be diagnoses. A number of the PDs have be eliminated or combined making it very difficult to use the diagnosis. Some will feel that this is a good thing-that Borderline PD is actually overdiagnosed. While this may be, I feel that the diagnosis meets a need, using behaviors and thought processes that help to direct treatment and therapy. Insurance companies will like it as it will make it easier to reject coverage for those who really suffer from the PDs that really interfere with people functioning on a day to day basis.

  1. Some areas may actually benefit from the DSM V. Too often, working with geriatrics, I find that doctors in HMOs do a perfunctory diagnosis of dementia, turning down diagnostic tests such as MRIs saying “So what difference does it make- dementia is dementia.” Well, “dementia is not dementia” and different types respond to different treatment and it makes a real difference. Now, the diagnosese will require appropriate testing and treatments will be able to be more specific.

  2. This DSM-V is going to be much more complex than one can imagine. Over the past year I havegone to the APA website and printed out everything that was available and I know that I, a mental health provider with diagnostic powers, will ahve to take a really intense course to gain any skills in this new process.

  3. My wife was an LICSW. To her, the DSM was not only a diagnostic tool, but equally importantly a list of things you could charge insurance companies for treating.

  4. As a therapist who has been trained using the DSM-IV-TR (Diagnostic and Statistical Manual 4th ed, Text Revision), I am perplexed by the various changes that have taken place and I’m almost certain this is a step backward.

    The problem(s) I have with the DSM-V are varied, but one BIG issue I have is with the new term for kids (ages 6-18yrs old) who have 3+ temper tantrums a week: ”Disruptive Mood Dysregulation Disorder.” The name itself sounds made-up and for me, reduces the integrity of the field and those who plan on using this label.

    I’m not sure we’re getting better (“progressing”), I feel that we, as a ‘science,’ are failing.

  5. There probably won’t be a DSM-6. There might be a DSM-5.1, or .2, but it’s doubtfull in 20 years the APA will still exist to publish another DSM.

    The lack of recuritment into psychiatry has been an issue for 20 years.

    In the last 3 years the APA went from 38,000 members in 2010 to 33,000 members in 2013. They lost 14% of their field in 3 years.

    The field is collapsing due to ‘scientific progress’ in neuroscience. Aparently Neurology was right and psychiatry was wrong, the mind isn’t seperate from the brain, people can’t medically have ‘Mental Illness’, just neurologic illness. Many, many things can cause the nervous system to malfunction – from vitamin deficiencies (like B-12) to thyroid problems to psychotropic drug effects. What use is a profession that arbitrarily turns subjective symptoms into their own diseases, and can’t tell the difference between any other illness and mental illness? Two psychiatrists interviwing the same patient can’t even reproduce a given diangosis.

    “Science Remains a Stranger to Psychiatry’s New Bible”

    “Psychiatry: A very sad story”

    “How a Scientific Field Can Collapse: The Case of Psychiatry”

    With any luck the field will finally go away!

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