How Do Controversial Revisions In Psychiatry’s Guidebook Make You Feel?
|By Stacey Burling, The Philadelphia Inquirer|
The official theme of the annual meeting, which opens Saturday at the
The current tome, the DSM-IV, was published in 1994 and updated in 2000. The book now in the works, the DSM-5 (yes, they dropped the Roman numerals), is due out by next year's APA meeting.
Supporters say the revisions incorporate more current science into the highly influential book. It also strives for diagnoses that show how seriously ill patients are.
Critics say the changes jump ahead of the science and expand what is considered mental illness. While the association tries to detect illnesses earlier and possibly prevent their most tragic symptoms, it risks calling essentially normal people mentally ill, needlessly exposing thousands to stigma and strong medicines, and handing drugmakers a bonanza.
One hot-button proposal allows grieving people to be considered depressed after two weeks of symptoms. Another addresses children who were being labeled bipolar by creating a different diagnosis: disruptive mood dysregulation disorder. Some worry that diagnoses meant to identify thinking problems in the elderly will turn normal aging into a disorder.
In what is surely biting criticism in the mental-health world,
The APA must have listened a little. It announced this week that it had moved the new attenuated psychosis syndrome, which attempted to identify young people likely to develop psychosis, and mixed anxiety and depression to a book section for conditions that need more research. They also tried to better differentiate normal grief from depression.
Last fall, Elkins, president of the
His and other groups are so miffed that they plan to write their own book. "We are calling for a summit in
One of the most vocal critics is psychiatrist
The new approach, he said, gives "drug companies a free pass to convince everyone in the world that they have one disorder or two or three."
There's also the matter of autism. Its proposed definition is more restrictive. That has caused an outcry from autism advocates, who fear children will lose school services.
Frances thinks his group has made the current definition too broad. If fewer children with mild symptoms are diagnosed, "that's a good thing."
He also thinks the APA has too much money at stake to be objective. He says it makes
The APA says it has invested
"We do want more public commentary," Kupfer said. "We are carefully examining this with some of our review groups. We certainly do not want to make changes for the sake of making changes."
For the record, he said, the number of diagnoses is dropping from 280 to 220.
While people assume that thinking of mental illnesses as brain disorders will lead to more medication, Insel said his agency has funded research into cognitive training, therapy that uses the brain's ability to change. It also is studying diet and family support.
"There is no biochemical imbalance that we have ever been able to demonstrate," he said. "What we think about are changes in circuitry and how the brain is processing information."
It makes sense to him to try to identify at-risk youths before they develop symptoms that can devastate their ability to work or have fulfilling relationships. The most debilitating of the mental illnesses, schizophrenia and bipolar disorder, often are diagnosed in early adulthood, but researchers are studying signs that emerge years earlier.
Critics say that lots of teens have eccentric behaviors but won't become mentally ill. This is true, Insel said, but "science entirely supports" figuring out who's going to become psychotic and preventing it. "That doesn't mean medicate earlier," he said.
The institute has embarked on its own attempt to classify mental illnesses based on what's happening in the brain rather than on symptoms.
Asked whether the association should delay rewriting the DSM until the science advances, he said, "That's a fair question. I'm not going to answer it." Then he said, "I think the DSM-IV is extremely helpful."
But he found the new approach to personality disorders "clinically impractical."
Overall, he said, "I honestly don't think it's going to make a huge difference in how I practice psychiatry." His prescriptions, he said, are based on symptoms, not diagnoses.
On Saturday, as psychiatrists inside the convention center discuss proposed DSM changes, protesters outside plan to "Occupy the
"We'd have to be
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