More Ways To Be Crazy

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The American Psychiatric Association (APA) is nearing completion of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This will be its first major revision in 17 years. Work on it had already begun 15 years ago when the DSM-4 was only a few years old. The DSM drives research, treatment, health insurance, and public benefits decisions (disability and special needs school services). So you can imagine just how highly charged and politicized the process is of revising the DSM.

The main decision makers behind the DSM are the APA and the mental health branch of the National Institutes of Health (NIMH). The actual revisions are done by workgroups, who collectively are considered an independent third party review. There are 160 members of the DSM-5 workgroups: 97 (MD) psychiatrists, 47 (PhD) psychologists, 2 (MD) pediatric neurologists, 3 (PhD) epidemiologists and then 1 each from (MD) pediatrics, social work, psychiatric nursing, speech/hearing specialist and a consumer group. The one nurse on the workgroups is Barbara E. Wolfe, ARNP, PhD—a psychiatric nurse practitioner on faculty at Boston College and an expert on eating disorders.

There is a DSM-5 website with information on the background/history of the DSM-5, workgroup members names/affiliations, and updated lists of proposed changes to be included in the DSM-5. The developers of the DSM-5 have already held two open public comment sessions on their website, and the third and final public comment session is slated for April. They report that their work is 90% complete, and that they will finalize the DSM-5 by December 2012 (publication date May 2013).

There’s been a fair amount ofnews coverage of several of the proposed DSM-5 changes, most notably a tightening of the definition of Autism, as well as changes in the definition of Bipolar Disorder. In reading through the updated proposed changes to the DSM, I came across the following items of interest. “Stuttering” is being renamed “Childhood Onset Fluency Disorder.” “Hypochondriasis” is being renamed “Illness Anxiety Disorder.” And under the diagnostic category of “Mood Disorders” (includes Depression), they are adding “Premenstrual Dysphoric Disorder. Proposed new mental conditions (listed as ‘under review’) include Apathy Syndrome, Internet Addiction, Seasonal Affective Disorder, Parental Alienation Disorder, and Male-to-Eunuch Gender Identity Disorder (ouch!). They need an “Overdiagnosis of Mental Disorders Disorder Syndrome,” then everyone including the DSM-5 members will be covered.

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