Psychiatry 'bible' structure overhauled
May 4th, 2011
05:44 PM ET

Psychiatry 'bible' structure overhauled

Reflecting a new understanding of many mental illnesses, the proposed organization for the newest edition of the "bible" of psychiatry is now open for public comment at dsm5.org.

The American Psychiatric Association this week released its vision for the next Diagnostic and Statistical Manual of Mental Disorders (DSM V). The updates incorporate insights from research since 1994,  the last time the manual was issued with substantial changes, the organization said. Publication of the DSM V is scheduled for 2013.

An earlier version of proposed information for the DSM V was released in February 2010. Tuesday, the American Psychiatric Association put out a more specific framework for how the new manual would be organized, showing connections between disorders that were previously unlinked. The goals are to call attention to commonalities and underlying vulnerabilities in certain groups of conditions, and to spur further research in those areas, said Dr. Darrel Regier, director of the Division of Research at the American Psychiatric Association.

"This organizational framework is trying to emphasize that we don’t have strict divisions between disorders," Regier said.

For instance, Asperger's syndrome, a high-functioning form of autism, instead of being its own diagnosis, would now fall under the broader “austism spectrum disorders.” This move has some parents unhappy because "autism" sounds scarier than Asperger's, which has taken on its own identity in that community, and because children with Asperger's have specific educational needs that are different from kids with more severe autism.

But the association has heard from other parents frustrated that their children with Asperger's are denied special education benefits reserved for autism, Regier said. And biologically speaking, Asperger's is a form of autism, doctors say.

There are many other notable changes. For instance, binge eating now gets an official diagnosis as an eating disorder. Anorexia has been redefined so that it doesn't necessarily include amenorrhea, since there are some women with this eating disorder who do have some menstrual activity. These revisions and others may help patients previously classified as "eating disorder not otherwise specified" (EDNOS), which had rendered some people ineligible for adequate insurance coverage for proper care.

And "Obsessive-Compulsive and Related Disorders" is now its own category, which includes OCD in addition to separate diagnoses of hoarding, skin-picking disorder, hair-pulling disorder (trichotillomania), and body dysmorphic disorder, among others. The rationale is that these conditions are all related, but are distinct and may require different treatments. For example, people with hoarding won't necessarily respond to the same psychotherapy or medication typically given for OCD, Regier said.

The revisions will be open for comment until June 15. Field trials will take place over the summer to test out the revisions in clinical settings. The American Psychiatric Association hopes to put out its next update on the DSM V after January 1, 2012, Regier said.

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