So, some pretty big news about the latest version of the Diagnostic and Statistical Manual of Mental Disorders (or simply “DSM” -this will be version 5). On Saturday it was announced that the American Psychiatric Association has preliminarily approved the major changes in the latest edition.
The DSM is the standard for the criteria for mental disorders in the United States, and generally determines what most insurance companies will cover. The manual has been considered somewhat outdated for several years, which is why this newest edition has been compiled. Revisions have been happening for over a decade, so the news that changes in the new DSM-V have been approved is definitely long-awaited.
I think I can safely say that any changes to a disorder people have been diagnosed with, or the total removal of a disorder is unnerving at best, and there are several changes in the new DSM that many people are getting worked up about. Generally, people are opposed to change, so even though the changes in the DSM (made by many of the leading doctors in the nation) have been made with the best intentions, you can expect to be hearing that some people are upset about the way the latest edition has panned out.
Personally, I’m not a doctor or a scientist, so I don’t really understand the implications that some of these changes have. Will it help more people? Will it help less people? I don’t know. I am already wary about the diagnostic process in America and often wonder whether a diagnosis helps more often than not… but there are several conflicting schools of thought on this subject, none of which I find myself subscribing to whole-heartedly.
So, here are a few of the bigger changes (that I’ve seen many people becoming upset over or overjoyed about) for better or worse:
Gender Identity Disorder has been removed from the DSM, with the new phrase “gender dysphoria” being used to describe emotional distress over
“a marked incongruence between one’s experienced/expressed gender and assigned gender.”
Many people in the GLBT community are heralding this as a welcome (and groundbreaking) change, because it separates the issues of gender identity and disorders, suggesting that gender identity issues are not the product of having a disorder of some kind.
Autism Spectrum Disorder is the new umbrella term for a number of previous diagnoses, including autism, Asperger’s syndrome, pervasive developmental disorder – not otherwise specified (PDD-NOS) and childhood disintegrative disorder. With this new spectrum diagnosis, all previous individual diagnoses no longer exist.
Many people are extremely concerned about this change out of fear that their insurance coverage will change, and intense confusion with feelings of loss around these old diagnoses and what the new diagnosis means.
From what I understand, this new model has many benefits -they simply have not fully been explained at this point. But, by using a spectrum model, doctors will be able to diagnose based on the severity of symptoms, rather than by using a checklist. Also, according to a number of websites I found, patients will not be losing their current diagnosis unless there is some reason to re-diagnose them. Granted, as I said, I can imagine how it must be difficult to hear a diagnosis someone may have worked long and hard to identify and clarify is no longer going to given to others, so all we can really do at this point is wait and see what happens.
No More “Bereavement Exclusion” for MDD means that if a patient has symptoms of depression after two weeks after the death of a loved one, they can be diagnosed with major depression. Previously, symptoms (that would normally be considered depression) would not be labeled as depression if they were related to the death of a loved one.
More additions and changes are included for binge eating disorder, disruptive mood dysregulation disorder, excoriation (skin-picking) disorder, hoarding disorder, pedophilic disorder, post traumatic stress disorder, and substance use disorder.
Currently, only major changes are being released, so I am patiently awaiting when we can find out about more minor changes. I’m curious to see if any of the changes that were proposed for bipolar disorder will have made it into the new edition. The long awaited DSM-V will be published in May, 2013.