Years in the Making, Controversial New Psychiatry 'Bible' about to Launch

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Controversial new psychiatry bible to be released

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TORONTO, Cananda - It took more than a decade to write. Hundreds of mental health experts contributed to the laborious process. And still, before the first spine has been cracked on the latest iteration of the bible of psychiatry, the new DSM-5 has caused quite a stir.

Critics contend the newest version of the Diagnostic and Statistical Manual of Mental Disorders risks creating diagnosis-creep, with broader definitions that will encompass more people and medicalize things such as normal grieving.

Some have suggested the new reference manual will create false epidemics, with many more children and adults being diagnosed with mental health disorders for which they may be offered powerful drugs.

The Society for Humanistic Psychology is among those complaining about changes in the DSM-5. It argues in particular with the lowering of some diagnostic thresholds, such as the reduction in the number of criteria needed to receive a diagnosis of attention-deficit and hyperactivity disorder (ADHD).

Brent Robbins is president-elect of the Society for Humanistic Psychology and co-chairs the organization's DSM-5 response committee. Robbins points to the DSM-5's elimination of what is known as the bereavement exclusion as another place where the new criteria may end up drawing in people who shouldn't really receive a mental health diagnosis.

In the DSM-IV, a person grieving the death of a loved one could not be diagnosed with major depression in the first two months after that loss. The new manual drops that waiting period, arguing that bereavement can trigger a major depressive episode and people suffering in this way should not have to wait for care.

But Robbins says the change means people coping with normal grief could end up with a diagnosis of major depressive disorder that would stay in their medical records for a lifetime.

"We would essentially take somebody who is going through a normal, transient human experience and say that they have a mental disease," says Robbins, an associate professor of psychology at Point Park University in Pittsburgh, Penn.

But the physician-in-chief at the Centre for Addiction and Mental Health (CAMH) in Toronto says the claims that psychiatry will draw in multitudes of new cases are unfounded.

"We are not in the business of walking through schools and trying to find a client that we don't need so that the wait lists at CAMH for child psychiatry go from ... three months to now six months or from six months to 12 months," says Dr. Benoit Mulsant.

Mulsant suggests the aim of the new publication is to right some wrongs in the previous version of the DSM and to help people who are hurting from mental health disorders.

The DSM is produced by the American Psychiatric Association, and will be released by the organization at its annual meeting this weekend in San Francisco.

This is the first full revision of the manual since the DSM-IV was released in 1994. Much has been learned in that time and the new edition will reflect the evolving science. And yet, something that hasn't changed is perhaps at the root of much of the arguing that has gone on about the new reference manual.

Unlike cancer or diabetes, which can be confirmed by studying the results of a biopsy or the readings of a blood test, mental health disorders are still diagnosed by symptoms.

There is no blood test that can distinguish transient attacks of the blues from depression, no imaging technology that differentiates normal high-spiritedness from ADHD. …