An updated manual of guidelines for the diagnosis of mental
disorders goes on sale Wednesday after stoking long-standing
controversy over its new characterization of some disorders,
including combining autism disorder and Asperger's syndrome as
different levels of the same problem.
Diagnostic and Statistical Manual of Mental Disorders 5, which
the American Psychiatric Association made public Saturday at its
annual meeting in San Francisco, contains guidelines that mental
health professionals use to diagnose and treat mental disorders.
But DSM-5 has kicked up controversy ever since the APA announced
plans to group autism, Asperger's, childhood disintegrative disease
and pervasive developmental disorder as different levels of the same
That, among other changes from DSM-4, released in 1994, prompted
the National Institute of Mental Health to announce three weeks ago
that as the world's largest funding agency for research in mental
health, it was withdrawing support for the manual. It said it won't
fund research projects that rely exclusively on DSM criteria because
it considers the manual to be lacking in scientific validity.
Other issues subject to debate include disruptive mood
dysregulation disorder, a diagnosis for children who regularly
overreact with temper tantrums, which will replace childhood bipolar
disorder. The manual also will consider bereavement of a loved one
as a potential form of depression if it shows potential to lead to
But the category of autism spectrum disorders is a lightning rod
"There can be enormous differences between someone with
Asperger's syndrome versus someone with autism," said Brent Robbins,
who heads the psychology department at Point Park University and is
a leading critic of DSM-5. "You lose information when you go in the
direction of reducing the categories from four to one."
He said the rationale for the change is unclear.
"I don't know why they're doing that, moving in the direction
that seems to get rid of distinctions," he said. "There might be
some similarities in treatment, but the more severe autism disorder
can require medication due to management of aggressive behaviors or
self injury, which is less likely with Asperger's."
David Kupfer, chairman of the DSM-5 Task Force and former
chairman of UPMC's Department of Psychiatry, said it's more accurate
to identify the four as different levels of one mental illness,
which allows clinicians to determine how disorders may relate to
each other based on symptoms and better determine treatment and
availability of educational and rehabilitative services.
"The basic problem is that those disorders could not be separated
out from each other in an intelligent way for clinicians to make
specific diagnoses," he said. …