New DSM-5 was released

[Mister T 45020]

For those that are interested in the field of healthcare, psychiatrics in particular, the new DSM-5 was released earlier, not without stirring some reactions. The following comes from CBS news (i've read other articles in french today as well):

 

The controversial revision to psychiatrists' "bible" of diagnostic criteria has finally arrived. The American Psychiatric Association released its fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or dubbed simply as the "DSM-5."

 

The manual's release was coincided with the APA's annual meeting that kicked off May 18 in San Francisco.

 

The first major revision to the manual in almost two decades, the new DSM has been met by controversy since reports of proposed changes started to crop up last March.

 

Doctors often utilize the DSM to diagnose mental health disorders in patients that meet a specific set of criteria.

 

Among the major changes that garnered the most controversy was dropping Asperger's syndrome, child disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD), and included them under the blanket diagnosis of autism spectrum disorder.

 

Revisions were also made to diagnostic criteria for mental health disorders including schizophrenia, bipolar disorder, dissociative identity disorder and depressive disorders.

 

For example, in the last version of the manual, the 1994 DSM-IV, there was was an exclusion criterion for a major depressive episode that was applied to people with symptoms of depression lasting less than 2 months following the death of a loved one. The DSM-5 removed this after the APA realized since the last version that grief can last up to two years, and bereavement can be a severe psychological stressor that triggers depression, rather than an exception.

 

Besides worrying some mental health advocates over concerns changes in their diagnosis would affect their abilities to get treatment for state funding, the manual's release also pitted the government's National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA),

 

NIMH director Thomas Insel wrote in a statement in early May that the NIMH felt the proposed definitions for psychiatric disorders were too broad and ignore smaller disorders that were lumped in with a larger diagnosis.

 

"The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever," he wrote.

 

The government agency said it would use a different classification system, the Research Domain Criteria (RDoC) project, instead for its studies.

 

The NIH and APA released a joint statement on May 13, saying that "patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care." But, the statement also said, "The National Institute of Mental Health (NIMH) has not changed its position on DSM-5."

 

A petition was also started by doctors to protest the new DSM.

 

One vocal critic, Dr. Allen Frances, who co-authored the DSM-IV, told CBS This Morning on Thursday that we are over-treating people in this country who are "basically well" and are "shamefully neglecting" people with mental disorders who are really sick, including one million people in prison with psychiatric disorders. The new manual, he said, is too loose for its diagnoses.

 

He said the average diagnosis is being given by a primary care doctor in a seven minute visit.

 

"People who are basically normal are getting all kinds of medicine that they don't need that makes them worse and it is a terrible drain on the economy," Frances said.

 

"I'm very curious to see what happens because as you know there's kind of this tension between the DSM and some of the new NIMH initiatives," Dr. James Murrough, an assistant professor of psychiatry and neuroscience at Mount Sinai Hospital in New York City, told CBSNews.com Murrough was not involved in the new DSM, but will be presenting research at the APA meeting this weekend.

 

He said by now, some psychiatrists had hoped the new DSM would contain more information about scientific tests or scans for psychologists or psychiatrists to help aid their diagnoses. But, he added the new version doesn't appear to look very different from the last one.

 

"I think everyone is kind of disappointed that we don't have that yet," he said.

 

More information about the DSM-5 can be found on the APA's website.

[Guest S****r]

The NIH and APA released a joint statement on May 13, saying that "patients, families, and insurers can be confident that effective treatments are available....

 

Absolutely, unequivocably untrue....not only in the U.S., but here in home sweet home Ottawa. Ask me about the Ottawa Mental Health System and I can give you an earful!

 

Thanks for the info here, though, mistert!

[Mister T 45020]

Another article, in french (through Google Translate), written by Phillipe Mercure from La Presse. The author highlighted some new additions to the DSM-5 (bottom of the page).

 

A manifesto. Petitions. Calls for a boycott. The new DSM, the bible of psychiatry to be adopted officially today, raises an outcry. The case against him: casting the net too wide and into mental illness normal behavior. Psychiatrists are they manipulated by the pharmaceutical industry to sell pills?

 

"Everyone I know who has a little fun is bipolar or has attention deficit," said Jean Leloup during a recent visit to the show Tout le monde en parle.

 

The singer would then expose the tendency of psychiatrists to increase diagnosis, an issue so explosive relaunched today as the American Psychiatric Association in San Francisco officially unveils its new bible.

 

Known as code DSM-5, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, however, has not a title to ignite the crowd. But the document, which could be accessed by a handful of observers last weekend and that some of the content has long been known, causes an unusual controversy in the scientific community.

 

Crises to childish "crisis", problematic grief, binge eating or scratching excessively, the new manual lists 297 officials mental illnesses, including several new ones. It's too much in the eyes of many critics, who believe that science goes too far in stating problems of normal behavior.

 

Allen Frances, a psychiatrist at Duke University, oversaw the fourth edition of the DSM, published in 1994. He has publicly stated that the publication of the fifth version of the manual represented "a sad day for psychiatry."

 

The pharmaceutical lobby

 

In a book entitled Saving normality and on the topic, Mr. Frances denounces what he calls the "medicalization of everyday life." According to him, the scientists who write the DSM-5 are influenced by the pharmaceutical industry, which seeks to increase the mental health diagnoses to sell drugs supposed to solve.

 

Jean-Francois Pelletier, a professor and researcher at the Department of Psychiatry at the University of Montreal, also believes there is a danger to multiply diagnostics.

 

"Having an accurate diagnosis, with sometimes too specialized of a terminology, can make people stigmatize themselves and lead them to self-branding," said the specialist. According to him, that psychiatrists use the DSM-5 will be just as important as its content.

 

"The way to report a diagnosis to a patient, the tone, the explanations are extremely important," he says.

 

In the United States, the National Institute of Mental Health has also stated its intention to distance himself from the DSM. "Patients with mental disorders deserve better," wrote the organization, which has however been tempered his remarks. In a statement, she said that the DSM is "the best information currently available for the clinical diagnosis of mental disorders."

 

Notably used by insurers to determine which treatments will be reimbursed, the DSM influences the practice of psychiatrists worldwide. Those who defend the claim that the DSM is not a catalog that the general public should peel to find problems, but a tool for experts to help them identify a set of symptoms in their patients.

 

Many psychiatrists also argue that the introduction of new disorders in the DSM-5 will make less severe diagnoses in their patients.

 

DSM-5: some new controversies

 

> The disorder of deregulation, aka explosive mood

 

This disorder targets children over age 6 who throw more than three big tantrums per week for one year. Critics fear that the introduction of this new disorder will medicalize mundane childish crises, while supporters say it will decrease diagnoses of bipolar disorder.

 

> Binge eating

 

It is defined by recurrent episodes of absorbing a disproportionate amount of food on one occasion. These episodes are accompanied by feelings of loss of control, disgust and guilt, and must occur once a week for more than three months.

 

> Hoarding

 

It is the accumulation of objects in a compulsive and excessive. Of worthless objects crammed point talking to harm the quality of a person's life and safety of the place. This disorder became known from 2010 through TLC, who devoted a television series called Hoarding: Burried Alive.

 

> The dermatillomanie (edit - google trnslate didnt catch this one)

 

The people who suffer are called in English the skinpickers. This disorder is characterized by compulsive self-harm, by scratching and uncontrolled triturage skin and pimples. It is associated with feelings of anxiety and guilt.

 

> Mourning

 

Until now, there are no diagnosed major depressive episode in someone who lived in mourning for less than two months. The DSM-5 will remove this exception, so that recent bereavement may also be reported depressive.

 

> Rejected Disorders

 

The hyper, addiction to sex or the addiction to the Internet have been rejected, as a condition called "paraphilic coercive." According to Dr. Allen Frances, the inclusion of the latter in the DSM-5 would have made rape mental disorder, not a crime. However, the term appears in the Appendix, what denounces the psychiatrist.

[danjo 257]

The DSM is really just a checklist of symptoms, and a useful tool for mental health providers in the sharing of information. Personally, I dislike diagnoses. In my opinion, it is much better to take a holistic approach with regards to interventions of a mental health nature. A simple diagnosis is often quite limiting, and can sometimes do more harm than good.

[Guest *Ste***cque**]

This latest DSM is just a lot of infighting amongst mental health service providers and I don't see where it has any bearing in my life.

I'm with danjo, in that a lot of these diagnosis are just labels. "Oh, thank God, the DSM has a label for my behavior. It's called sexual addiction". Some people might say "good, I'm not responsible" while others might just admit that they lack impulse control. Of course like anything, it's all a matter of degrees.

 

I prefer to take a holistic approach to my mental health.

 

NOTE: I am sympathetic to mental health issues as I suffer from anxiety and have had a few bouts of depression in my life. They are real and debilitating. I just don't think a label has ever helped me. It's always been a holistic approach that has helped me. When my mind is afflicted I work on my body and vice versa.

 

During my last bout of depression when I said to my wife I think I am going crazy, she said in a sympathetic voice, "Steve, don't worry, we're all a bit crazy". Hearing her say that helped me more than you would think. I took from those words that I'm not alone in this battle. For me, it was just the right thing to say to me. Now whenever I feel down, I think of those same words and it helps.

 

So, if you are feeling a bit crazy I say "Don't worry, we're all a bit crazy", and you don't have to feel so alone.