How Psychiatrist Manual Revisions Change Mental Illness

The big changes: child bipolar disorder and Asperger's

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The American Psychiatric Association recently previewed some of the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, colloquially known as the DSM. Any alterations to what The Washington Post calls "the massive tome that has served as the bible for modern psychiatry for more than half a century" have a major impact on how mental illnesses are diagnosed, and inevitably attract controversy. As one Huffington Post blogger noted, "you haven't seen infighting until you watch psychotherapists and others who worship at the mental health altar argue over the DSM." The new edition has started debates over juvenile behavior disorders, sex addiction, binge eating -- but the the big changes, say those in the know, are to Asperger's and child bipolar disorder.
  • Reduction of 'Bipolar' Label for Children  Calling this "a move that could potentially change mental health practice all over America," NPR'S Alix Spiegel writes of the inclusion of "a new diagnosis" that the association "hopes ... will be used by clinicians instead of the bipolar label" when dealing with young patients. Spiegel traces the controversy over bipolar diagnoses for children from the emergence of the trend to the height of its popularity and the backlash. Though the diagnosis has "some real advantages," including letting parents "off the hook," putting the label of a lifelong condition like bipolar on a child is risky.
  • Controversial, But Bipolar Change Is Good  F. Paul Wilson at True/Slant is one of those welcoming the shift away from the bipolar diagnosis. "Children with bipolar disorder are treated with anti-psychotics," he explains, "which, to be frank, I, as a primary care doc with just enough knowledge in this field to be dangerous, find scary as hell." He finds it even more frightening to contemplate these drugs' effect on a child misdiagnosed with the neurochemical bipolar disorder, and who instead actually has a behavioral disorder. As for the fracas over the DSM in general, he writes: "A new DSM is always controversial, as it should be. In essence it defines who’s normal and who’s not."
  • Asperger's No Longer Separate From Autism  Tracy Staton at FiercePharma says "one of the biggest [changes] is the elimination of some specific diagnoses that [the committees] view as subsets of broader illnesses ... Asperger's syndrome, for example, would be folded under an umbrella diagnosis of 'autism spectrum disorders,' on the milder end of that spectrum." The New York Times' Benedict Carey says this is one of the changes that has been "widely discussed" and "the subject of intense speculation and lobbying" for months. Becky Jungbauer at ScientificBlogging also highlights this change.
  • Reasons to Doubt the Changes  Merrill Goozner, former reporter for the Chicago Tribune, is concerned about conflicts of interest in the DSM review process. "Dozens of psychiatrists who serve on the DSM-V (it's the fifth edition) task force and working groups have financial ties to the pharmaceutical and medical device industries, as well as to numerous patient advocacy groups." Thus, even if the task force's recommendations are legitimate, they will be "bathe[d] ... in a layer of doubt," as critics point to these ties.
This article is from the archive of our partner The Wire.