Update of Manual Raises Questions for Psychiatrists in U.S

Article excerpt

As the American Psychiatric Association takes another step closer to major revisions in the field's most iconic diagnostic tool, many mental health care professionals are wondering about the consequences they'll face in practice.

Their questions cover a wide range of practical applications, ranging from diagnostic labels to insurance coverage and electronic filing systems. They know their patients are going to have concerns as well.

"People are upset about the changes in autism spectrum disorder diagnoses because it might mean that their kids won't be eligible for treatment and services," said Peter Rao, a psychiatrist in Tulsa. "Those are the kinds of changes that people are worried about."

Psychiatrists met this week in Philadelphia to review the ongoing process of revising the Diagnostic and Statistical Manual for Mental Disorders, or DSM, the bible or field guide of mental disorders. The hefty tome outlines each mental illness with a checklist of symptoms to help professionals clarify their treatment plan. The DSM has been in its fourth edition for about 30 years without a major update. The APA has been working toward the DSM-5 for more than a decade in order to better reflect new information in neurology, genetics and the behavioral sciences to improve mental health care.

Such an undertaking has been rife with conflict among peers, of course, the majority of which has not been obvious to the general public. And as the final version approaches - the planned release is May 2013 - the APA has invited public comment on the proposed criteria, which has led to a more transparent level of discourse over the fine details.

Take depression, for example. Rao said one of the more controversial revisions under consideration would loosen up the allowance for grief over the death of a loved one to be classified as severe depression for treatment. Rao, who heads the Depression and TMS Therapy Center of Tulsa, said he and many of his colleagues believe grief is a normal response to loss that may involve depressive symptoms, but that the proposed DSM-5 entry unnecessarily medicalizes the healing process.

Gender identity disorder is also on the way out. People who believe the sex they were born with doesn't match their gender identity will still potentially qualify for insurance-backed treatment, but they won't have to be labeled with the word "disorder" anymore. Instead, it will be called "gender dysphoria."

The family of developmental disorders that includes Asperger's and autism will likely be consolidated under a single classification formally referred to as "autism spectrum disorder" because their differentiations overlap so much. …