By David Joel Miller.
UPDATE – changes in the DSM.
You can erase most of this post from your memory. During the process of updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the DSM-IV to the DSM-5 a lot of things were proposed. Some of those suggested changes were instituted and others were left out. This post includes mostly ideas that did not make it to the final DSM-5. Because these ideas were included in a lot of research articles and other blog posts, I have left the post up but need to tell you that some this information is now out of date.
Mental illnesses appear and disappear like magic – More DSM-5.
The effort to improve and refine the Diagnostic and Statistical Manual of Mental Disorders continues. This round of revisions has created a lot of concern about the way in which things we thought we knew about the nature and treatment of mental illness can change dramatically in a short time span.
There has been a lot of opposition to some of the proposed changes from both inside the American Psychiatric Association (APA) and those outside the association who have to work with the manual. The effects for consumers and clients may not be obvious for some time.
Recently the APA posted a notice on their website about changes they are making to the proposals for the new edition of the DSM. Not surprisingly, those revisions in proposals have coincided with the APA’s convention. The pressure to get this worked out is on now as the new edition is due out next year at the May 18-22, 2013 APA convention. That means the decisions need to be made and the book sent to the publishers by the end of 2012. The APA is accepting comments on their website from May 2nd to June 15th, 2012.
Most of these ideas are tested in carefully controlled trials with strict adherence to criteria. Unfortunately in daily practice clients don’t come in with only one problem and clinicians don’t have the time or resources to do extensive testing and diagnosing. The question remains, will this new understanding of mental disorders help or hinder the efforts to get clients the best possible care and still stay inside agencies budgets?
Here are some of the most recent changes
1. Mixed Anxiety and Depression
This is getting moved to the back of the book under diagnosis for further study. We know that clients often have both of these together but then they also may have diabetes and sore throats but so far we are not creating lots of combo diagnosis. Bottom line if you have two mental illnesses you get two diagnoses, not one “combo,” for now.
2. Attenuated Psychosis
This moves to the back of the book also. We have plenty of psychosis class diagnosis, not sure one more will make any difference.
3. Depression gets a footnote about being careful not to make normal things into mental illnesses.
But that always has needed some judgment. If it is causing you too many problems it gets diagnosed if it is within normal it does not. So we still try to keep categories of illnesses while we also allow for variations in degree.
4. The Non-Suicidal Self-Injury Diagnosis (often called cutting)
So far has not worked the way they thought it would. Some have proposed adding Suicidal Behavior Disorder also. Currently, neither of these is considered a mental illness. They are symptoms of something but we are not all agreed on what they are symptoms of. These two are likely to end up in the back of the book along with that complex grief thing.
So the announced changes in the draft move us back closer to where we were before – except that to this point the APA is staying with their proposed changes in Autism and Substance Use Disorders. Only time will tell.
Staying connected with David Joel Miller
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