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New And Improved? The Proposal for DSM-5 Is Here

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression ...Read More

After working on it for 11 years, the American Psychiatric Association has finally unveiled their proposal for the revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), rightfully drawing attention from The New York Times, The Wall Street Journal, The Daily News, and other media.

            This mammoth project of revising the DSM was sponsored jointly by The American Psychiatric Association and The National Institute of Mental Health. It also included collaboration with The World Health Organization (WHO) in order to make the DSM more compatible with the diagnostic system used by the WHO, the International Classification of Diseases (ICD-10).  The revision process comprised years of conferences and meetings of more than 500 experts – clinicians and researchers – from all over the globe.  The focus was on looking at the last incarnation of the DSM, evaluating what worked and what did not, and then revising it so as to make it as clinically useful as possible. There was a strong emphasis on basing the new recommendations on scientific research wherever possible. Furthermore, the edition represents an attempt to strike a balance between maintaining continuity with the previous editions, versus being open to all changes necessary to improve the diagnostic system.  The resulting proposal was posted today at www.dsm5.org for the public to review and comment on, and will be available until April 20, 2010.

In the months ahead, the plan is to conduct field trials in which the proposed changes will be tested in terms of how well they work in both clinical and research settings.  Participating research sites should be recruited by May 2010, starting off a series of research endeavors that are planned to be completed by March 2011. The data obtained in these projects will be analyzed and will identify necessary changes to the current proposal.  Those revisions are supposed to be posted again for public review from May to July 2011, followed by a second wave of research on any modified diagnostic criteria.  This then will be presented to The National Center for Vital and Health Statistics’ Annual ICD-10-CM Revision Conference (representing the WHO’s diagnostic system), as well as The American Psychiatric Association Assembly and Board of Trustees.  The final result is supposed to be published in May 2013.

            Just like the previous iterations of the DSM, the current proposal reflects the state of the art research of our time, as well as our understanding of mental illness and treatment.  It also reflects just how hard it is to conceptualize what mental illness and mental health are.  Any small revisions to the DSM can draw big consequences in terms how we think about mental health issues in our society.  As such, the DSM is highly political in that any changes will affect not only diagnosis of mental illness, but also treatment, research, and funding.   

Amongst the proposed changes are the replacement of the term “mental retardation” with the term “intellectual disability”, the introduction of a diagnostic category of “autism spectrum disorder”, and the elimination of the category of substance dependence, replacing “substance use disorders” with “addictions and related disorders”. Some changes are proposed to the definitions and classification of eating disorders, as is the recognition of gambling as a behavioral addiction. Amongst the most controversial proposed changes is the inclusion of a new “risk syndromes” category, which is supposed to help clinicians identify early stages of mental disorders. Some experts, however, fear that this will lead to stigmatization early on in life, in that a young person might be identified as being at risk, and then carry the label for the rest of their lives even if they never develop the disorder.  Not surprisingly, advocacy groups and lobbyists have been rallying around the revised manual.

            Big changes are potentially ahead for the area of Personality Disorders. Stay tuned for a discussion of the proposed revisions for Personality Disorders in DSM 5 next week.

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