The Diagnostic and Statistical Manual of Mental Disorders
(DSM) is a large book that describes all the diagnoses the psychiatric community can make. Currently, the fourth edition (DSM-IV) is what psychiatrists use, and the fifth edition (DSM-V) is planned for publication in May of this year. The changes planned for the upcoming fifth edition have been controversial but the American Psychiatric Association (APA) is charging ahead with it. Here are a few changes that concern me.
1) Somatic Symptom Disorder
. This is when psychiatrists consider your unexplained physical medical symptoms to be "all in your head." The debate over this condition is what made me write this article, although honestly I have not seen it covered much in the mainstream media. Currently in the DSM-IV, one must be suffering with at least eight unexplained medical symptoms arising before the age of 30, from various specified symptom groups including gastrointestinal pain, resulting in psychosocial impairment, in order to be diagnosed with Somatic Symptom Disorder. In the updated DSM-V, you will only require one distressing physical symptom (not necessarily gastro-related) for six months and a doctor's perception that you are thinking too much about or are overly preoccupied by the symptom. It does not require
a thorough medical work-up before diagnosis. So when DSM-V rolls out in May, if for example you have joint pain for a few months and they don't know why, and your doctor thinks you're bugging him too much for an explanation, he can diagnose you with somatic symptom disorder
. Then come the antidepressants and psychotropic drugs...
Debate has raged about this since APA first described the upcoming DSM changes, but they are standing firm on their new diagnostic criteria for Somatic Symptom Disorder, as reported in the January 16, 2013 online edition of Psychology Today
. This means that people with functional diseases like fibromyalgia or irritable bowel syndrome, or those with systemic diseases where the diagnosis emerges over time, such as multiple sclerosis or lupus, could be easily misdiagnosed with Somatic Symptom Disorder, and their symptoms dismissed.
2) Generalized Anxiety Disorder (GAD)
: GAD is big business in the pharma industry. Currently
, you can be diagnosed with GAD if you have persistent feelings of worry and apprehension for at least six months and you find these feelings difficult to control. In addition, you need to have at least three of the following six symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. The updated DSM-V has shortened
the required duration of symptoms by half - three months - and reduced the number of symptoms required for diagnosis. This change in the definition of GAD may create millions of new patients
and add tremendously to the already booming medication industry for this condition.
3) Disruptive Mood Dysregulation Disorder
: No doubt you have heard of this one before. The addition of this condition to DSM-V effectively turns temper tantrums into a mental disorder. Starting in May of this year, if you are a child over age six and you have 'disproportionate' temper tantrums three or more times a week, you can be diagnosed with this condition. Not only will you have to live with this odd label
, but someday down the road, who knows what meds will be developed for it that mom or dad may make you take.
4) Adult ADHD
: The upcoming edition of DSM-V reduces by half
the number of symptoms required for a diagnosis of adult ADHD. As a result, many adults who would not have 'qualified' for an ADHD diagnosis under DSM-IV will meet the diagnostic criteria under DSM-V. This means millions of new patients may qualify for stimulant medication therapy.
: Prolonged grief will soon be categorized as Major Depression
. This is a controversial one but detractors say it opens 'patients' up to pharmacological treatment when they should be focusing on consolation from family and friends, and allowing themselves time
to heal. We all grieve at different rates and some take longer to get over the loss of a loved one.
6) Binge Eating Disorder
: Have you ever excessively overeaten more than 12 times in three months? Well, as of May 2013, you may qualify for a diagnosis of Binge Eating Disorder
. So much for eating too much at Sunday dinners!
7) Minor Neurocognitive Disorder
: This is another new diagnosis for the DSM-V. In May, it will become possible to diagnose people with this condition if they experience modest cognitive decline
that does not interfere with activities of daily living
. So basically, we are talking about mild forgetfulness that may be a normal part of aging, now labelled as a condition, in people who may have no risk of dementia.
Perhaps the worst proposed change to DSM-IV was the idea of labelling rapists as having a mental disorder
. Yes, apparently the wise folks at APA thought it prudent to label rapists as having a mental condition called "coercive paraphilia
," thus opening up the idea that such criminals could be committed to mental hospitals instead of jail. Thankfully, the APA listened to the outcry that ensued about this particular proposal and struck it down. But it makes you wonder with what recklessness and abandon psychiatrists on the DSM committee come up with these diagnoses.