Expanding catalog of mental disorders worries some

    The so-called bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, is getting a make-over. The latest version, DSM 5, will come out in 2013. In the meantime, conflicts over which diagnoses should be added, removed or changed are heating up.

    Thousands of mental health professionals who are not happy with the direction of the new DSM are signing an online petition.

    The DSM is a highly influential publication—it guides diagnosis, research and policy. The last edition of the manual was published in 1994, meaning this new edition must reflect almost 20 years of new research and treatment advances. The stakes are high, and so is anxiety around changes and additions.

    The online petition posted by several professional organizations for psychologists criticizes those working on the new DSM for what they call “lowering diagnostic thresholds.”

    Philadelphia psychologist Cindy Baum-Baicker, who has signed the petition, said the number of different mental health diagnoses is growing too quickly.

    “We already have 297 diagnoses. When we started the DSM, we had 106,” she said. “We’re going to have even more.”

    She is concerned about several specific aspects of the new DSM, for example changes that could turn prolonged grieving into a diagnosis. Grief, she said, is a natural and important part of life.

    “If we pathologize the sadness of grief, and we put people on medicine so that they don’t experience their sadness and feel it through, they oftentimes aren’t going to be making the changes they need to be making to get on with life,” Baum-Baicker said.

    University of Pennsylvania psychology professor Marna Barrett has not signed the petition—even though she shares some of the concerns it addresses.

    She said the professionals working on the DSM have been receptive to feedback—which she says is a good thing, but can also cause difficulties.

    “In no other aspect of medicine do we have a handbook of disorders where the public can put their two cents in as to what is a disorder or not, where colleagues can say this is a disorder or not,” Barrett said.

    Barrett said decisions about the DSM should be firmly based in evidence and research and not yield to social and political pressures, or lobbying efforts from interest groups such as advocacy organizations headed by parents or consumers.

    The online petition criticizing the DSM has collected more than 6,000 signatures so far.

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