On December 1, 2012, the American Psychiatric Association officially approved the final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The new ‘psychiatric bible' features a number of important changes to the existing canon, including the elimination and alteration of many familiar disorders. Here's what you need to know about the new guidebook.


Improvements in scientific understanding

The update, which is the first in twenty years, was compiled with the help of over 1,500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other disciplines from nearly 40 countries. The guidebook, which is used by clinicians and researchers to diagnose and classify mental disorders, will be released in the spring of 2013.


According to APA president Dilip Jeste, all of these revisions were the result of improvements in the scientific understanding of various mental illnesses made over the past two decades.

Unlike the classification of viral diseases and injuries, many psychological disorders lack validated diagnostic biomarkers, so psychiatrists often struggle to identify the right diagnosis. The APA hopes the DSM-V will provide clearer and more accurate diagnostic criteria for making clinical assessments.

And the APA trustees claim that they've been conservative in their approach to revising the new guidebook. The manual will include approximately the same number of disorders that were in the DSM-IV — going against the trend in other health fields. They did so by consolidating a number of conditions (like absorbing Asperger's Syndrome into the broader category of Autism Spectrum Disorder), while expanding more complex diagnoses into more discrete conditions (for example, Post Traumatic Stress Disorder now comprises four related sub-categories).


These changes, of course, come with ramifications. The introduction of new disorders may stigmatize people — potentially leading to discrimination, including difficulty in getting health insurance and finding a job. Also, narrowing certain criteria may result in fewer people getting formal diagnoses — having a heavy impact on insurance coverage and access to services. Needless to say, not everybody will be happy with these changes.

And on that note, here's what's new in the DSM-V:

Hoarding Disorder


Hoarding Disorder is now recognized as an official diagnosis — an addition that barely registers as a surprise, given its prevalence in today's society (there's even a reality television show dedicated to the condition). Psychologists will now be on the lookout for patients who have persistent difficulty throwing away or parting with their possessions — regardless of their actual value. Hoarding, quite obviously, has harmful effects, creating emotional, physical, social, financial, and even legal problems — both for the sufferer and family members.

Binge Eating Disorder

Binge Eating Disorder is also in. It got upgraded from its place in the "further study" area to the DSM-V's Section 2, with more details about the symptoms and behaviors of people with the condition. Unlike Bulima Nervosa, people with Binge Eating Disorder don't engage in follow-up behaviors like vomiting or the use of laxatives. Nearly 30% of patients enrolled in weight control programs suffer from this condition.


Excoriation Disorder

Compulsive skin-picking, what's called Excoriation Disorder, is also new to the DSM-V. It will be added to the section on Obsessive-Compulsive and Related Disorders chapter. People with this disorder pick their skin for no apparent reason and target various parts of their bodies. It can involve picking, pulling, poking, squeezing, tearing, and even some scratching. Often, the condition escalates when scabs are persistently picked at; the disorder often escalates into a more overwhelming form of compulsive skin picking in which the urge to scratch is unbearable — what becomes a kind of neurotic excoriation.


Disruptive Mood Dysregulation Disorder


Also new to the DSM-V is Disruptive Mood Dysregulation Disorder — a diagnosis for children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year. The APA trustees added DMDD to the manual to address a burgeoning problem in which bioplar disorder in children is being overdiagnosed and overtreated.

Autism Spectrum Disorder

As we reported a few days ago, Autism Spectrum Disorder got a significant overhaul. In addition to absorbing Asperger's Syndrome (which is now referred to as a high functioning form of autism), the Spectrum now includes Childhood Disintegrative Disorder (a condition in which children develop normally up until the age of 3 or 4 — but then quickly lose language, motor, social, and other skills already learned) and Pervasive Developmental Disorder (a nebulous term that has traditionally encompassed autistic-like characteristics).


Other changes

Posttraumatic Stress Disorder will be given special attention in DSM-V. Moving forward, PTSD will be broken down into four distinct diagnostic clusters instead of three. In particular, the new diagnostic criteria will pay more attention to the unique ways PTSD manifests in children and adolescents.


The APA trustees have also combined Substance Abuse and Substance Dependence into the singular Substance Use Disorder. According to a recent study, about 12% of people in the United States are addicted to alcohol, and 2-3% are addicted to illicit drugs.

The DSM-V also broadens Specific Learning Disorder to include issues with specific academic skills, a list that includes oral language, reading, written language, and mathematics.


The APA will stop using the term "pedophilia," instead referring to it as Pediophilic Disorder.

Though not official additions, disorders for 'further review' include Internet Use Gaming Disorder, Non-Suicidal Self Injury, and Suicidal Behavioral Disorder. These conditions, while they can be diagnosed, don't warrant reimbursement from insurance companies.


Rejections

The APA rejected several proposed diagnoses, including Anxiety-Depressive Syndrome and Attenuated Psychosis. Critics feared that this would have labeled millions of Americans with a mental disorder.


Other rejections included Hypersexual Disorder, Parental Alienation Syndrome, and Sensory Processing Disorder.

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