Psychiatrists offer diagnostic, treatment changes

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Psychiatrists offer diagnostic, treatment changes

Wednesday, February 10, 2010

By Shari Roan, Los Angeles Times

After years of research, professional infighting and maneuvering from various

interest groups, the nation's psychiatrists on Tuesday unveiled proposed changes

to the manual used to diagnose and treat mental disorders around the world.

The draft document, released by the American Psychiatric Association, for the

first time calls for binge eating and gambling to be considered disorders,

opening the way for insurance coverage of these problems. But it refrains from

suggesting a formal diagnosis for obesity, Internet addiction or sex addiction,

as some professionals had proposed.

The document also recommends a single category for autism spectrum disorders,

unifying what has been a multifaceted and complicated diagnostic scale.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

will be published in 2013. The book, which serves mental health professionals,

is also used by insurance companies making decisions on treatment coverage and

in courtrooms and schools. It was last revised in 1994.

The draft of the document will be displayed for public comment from today until

April 20 at www.dsm5.org, allowing for input from individuals and organizations

who may feel that they have been left out of the revision process.

" This has been a massive effort on the part of a very dedicated team, " Dr.

Kupfer, chairman of the DSM-5 task force said Tuesday in a news conference in

Washington, D.C. " Their priorities were to make sure the manual is based on

scientific evidence, is useful to clinicians and maintains continuity with the

previous edition wherever possible. "

DSM-5 is likely to list fewer diagnoses than DSM-4. Experts have proposed

folding several disorders into single categories, based on studies that suggest

that some disorders have similar origins, symptoms and treatments but only vary

in severity.

For example, the four separate diagnoses related to autism -- autistic disorder,

Asperger's disorder, childhood disintegrative disorder and pervasive

developmental disorder not otherwise specified -- would now be referred to as

autism spectrum disorders.

Moreover, separate personality disorders -- such as borderline personality

disorder and schizoid personality disorder -- would be referred to simply as

personality disorder.

And the current categories of substance abuse and dependence will be referred to

as " addiction and related disorders " -- a reflection that these problems cannot

be easily categorized as mild or severe, but occur on a continuum.

The loss of some categories is expected to be heavily criticized. People with

Asperger's disorder, considered a mild form of autism characterized by

difficulty with social relationships, see their condition as distinct, said

Geraldine Dawson, chief science officer for Autism Speaks, a research and

advocacy organization in New York. " These different labels become part of a

person's identity. I think we need to be sensitive to that, " she said.

Similarly, the proposal to place personality disorders in one category will not

be welcomed by patient groups such as The National Association for Personality

Disorders, which has championed specific research and treatment for one of

these, Borderline Personality Disorder.

" This will be a disaster, " said Porr, founder and president of the New

York-based organization. " It kind of trivializes the personality disorders. "

Another possible point of contention is the suggestion of a category entitled

" risk syndromes " to describe what may be early signs of a mental disorder. For

example, 25 percent to 30 percent of people diagnosed with psychosis have early

symptoms that include being suspicious of others and speaking nonsensically.

Some critics fear that categorizing people as " at risk, " when they don't yet

have a full-blown disorder, may lead to misdiagnosis and possible stigmatization