Proposed Changes to DSM go online
Tuesday, February 9th, 2010
People interested in mental health issues can get a sneak peak at the new Diagnostic and Statistical Manual of Mental Disorders online. Proposed changes will be published on a website for public review and feedback.
Listen to the radio reports:
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To view the proposed changes in the DSM, please visit www.dsm5.org
Simply put, the Diagnostic and Statistical Manual of Mental Disorders, DSM, is a big deal. Psychiatrists use it to diagnose people, researchers use it to develop studies, policy makers use it to allot funding and services.
The last Manual was published in 1994 – so the new edition has to reflect advances in research that have happened since then. One area up for revision is Autism. In the current DSM, it's broken up into distinct categories – autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder. The new edition will contain only be a single diagnostic category: autism spectrum disorder.
In doing so, the manual catches up with practice, says Dr. David Mandell of Philadelphia's Center for Autism Research:
Mandell: All of the components of autism spectrum disorders really are best conceptionalized on a continuum, rather than trying to break them artificially into discrete categories.
Having this current understanding of autism reflected in the DSM, says Mandell will make it easier to get services to children without having to fit them into narrowly defined categories .
Another change speaks to how society's vocabulary has changed in the last 16 years. The term "mentally retarded" will be replaced by "intellectual disabilities".
Robert Kreider is CEO of the Devereux Foundation, a service provider. He says this change is overdue, and stems largely from parents' advocacy:
Kreider: Families and other caregivers live with the realities of developmental disabilities every day, and it's important for all professionals that support those families to be respectful of their wishes and insights.
Kreider says recent examples of politicians and entertainers using the word "retarded" in a crude fashion show the need for this change.
The new manual won't be published until 2013
Dr. Mandell brings up a very profound point in that "autism spectrum disorders really are best conceptionalized on a continuum, rather than trying to break them artificially into discrete categories." This is most definitely true, except this actually applies to nearly all of mental illness, the old argument of dimensions vs. categories. The categorical nature of the DSM is the very reason why the manual is conceptually flawed to the core.
A new video lecture on the DSM and its failures has been prepared by the psychiatrist, Dr. Niall McLaren. It can be found under youtube username jockmclaren47 or links can be followed from his psychiatry blog http://www.NiallMcLaren.com.
Here are some quotes from his new book, Humanizing Psychiatrists (2010), regarding the DSM categorical system of diagnosis:
"Not even death is so clear that we can definitively operationalize its definition. In the field of mental disorder, which is murky and uncertain at best, this is even more true."
"That is, the DSM nosology of mental disorder is driven by the need to find a series of specific, internally uniform clinical pictures as the surface manifestation of specific unseen biochemical lesions. " "By answering the question of whether mental disorder is psychological or biological, we will ipso facto answer the question of whether the final nosology of mental disorder will be categorical or dimensional in form. Even though the (DSM) Committee has not overtly embraced the reductionist, biological model of mental disorder, they have shifted the focus of thinking by implication." (see chapter for details)
"If it emerges that the correct model of mental disorder is psychological in nature, and i have argued at length that it is, then the categorical model of DSM diagnosis will disappear as quickly as the psychoanalytic model did. Until this question is determined, openly and honestly, we are simply engaged in a vastly expensive exercise of drawing boxes in the sand, then watching impotently as the social winds blow them away."