NEW BOOK ON MENTAL DISORDERS CRITICIZED [Corrected 05/25/13]
Templeton, David, Pittsburgh Post-Gazette (Pittsburgh, PA)
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 disorder.
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 harmful behavior.
But the category of autism spectrum disorders is a lightning rod for criticism.
"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. …