Don’t say “mental retardation” — the new term is “intellectual disability.” No more diagnoses of Asperger’s syndrome — call it a mild version of autism instead. And while “behavioral addictions” will be new to doctors’ dictionaries, “Internet addiction” didn’t make the cut.
The American Psychiatric Association (APA) proposed major changes yesterday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what’s officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback via the Internet from both psychiatrists and the public about whether the changes will be helpful.
The manual suggests some new diagnoses. Gambling so far is the lone identified behavioral addiction, but in the new category of learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because binge eaters don’t purge.
Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders — such as dementia and schizophrenia — based on early symptoms, though there’s no way to know who will worsen into full-blown illness.
It’s a category the psychiatrist group’s own leaders say must be used with caution, as scientists don’t yet have treatments to lower that risk but don’t want to miss people on the cusp of needing care.
Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.
But overall the manual’s biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses — and urge doctors to concentrate more on the severity of their patients’ symptoms. Thus the draft sets “autism spectrum disorders” as the diagnosis that encompasses a full range of autistic brain conditions — from mild social impairment to more severe autism’s lack of eye contact, repetitive behavior and poor communication — instead of differentiating between the terms autism, Asperger’s or “pervasive developmental disorder” as doctors do today.
The psychiatric group expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.
“Is someone really a patient, or just meets some criteria like trouble sleeping?” APA President Alan Schatzberg, a Stanford University psychiatry professor, told The Associated Press. “It’s really important for us as a field to try not to overdiagnose.”
Psychiatry has been accused of overdiagnosis in recent years as prescriptions for antidepressants, stimulants and other medications have soared.
The update of this manual, called the DSM-5 or Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has been anxiously awaited.
It’s the first update since 1994, and brain research during that time period has soared.
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