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of research articles and other blog posts I have left the post up, but need to tell you that this information is now out of date.
Minor Depressive Disorder is out.
It did not even make the maybe section of disorders needing more study that is in the back of the DSM.
NEC or Not Elsewhere Classified is one of those left out ideas.
It was discussed as an improvement over the old Not Otherwise Specified (NOS.) A lot of people were receiving NOS diagnosis rather than a more precise or accurate diagnosis. In retrospect, I can see how NEC like NOS could have turned into another Fuzzy catchall diagnosis.
The final decision was for the DSM-5 to have two miscellaneous designations for things that do not fit nicely into a particular category. These two new designations are; Other Specified and Other Unspecified. When those two specifiers get used will need a whole other post but for now, just know that:
NOS is out
NEC is not in and does not replace NOS
Here is the old post:
The new sort-of depressive disorders
Minor Depressive Disorder is another one of those disorders that were proposed as somehow different from other depressive disorders. It was proposed in the DSM-4-TR as a condition needing further study.
The reason some researchers suggested this one is that the diagnoses in the DSM are yes or no things. You either meet criteria or you don’t, give or take some judgment calls we could describe as “clinical judgment.”
People do not come with discrete specific mental illnesses very often. They have problems and suffering and want help. To get that help we need to give them a “diagnosis.” The labels do not always fit well.
Minor Depressive Disorder was hard to tell from the other Depressive Disorders and does not seem to have made the cut for the DSM-5. (I am reading the on-line version; the paper version will not be out until next year.)
What we will have is a new group of Depressive Disorders Not Elsewhere Classified (NEC.) Here is my quickie version of the new categories. For the full version check the APA website for the DSM-5 or wait for the Book or the Movie version.
Recurrent Brief Depression
Every month for a year they have 2-13 days of depressive symptoms. This comes with a list of reasons to not give this one or other diagnosis that it might be.
Mixed Subsyndromal Anxiety and Depression
Lots of people who are anxious get depressed and people who get depressed can become anxious. This happens so often that a new Mixed Anxiety and Depression diagnosis was proposed. That one did not make the cut. So for full-on Depression and full Anxiety looks like we will continue to use both diagnoses. It will be interesting to read the full text on this one when the DSM-5 comes out. Somehow this Subsyndromal mix got its own label.
Short duration (4-13 days) Depressive Episode
So if your brief depression does not recur every month you can still get a depressive diagnosis. This one concerns me and I will need to learn more. It seems to open the door for anyone who has ever had a “blue week” to now get a diagnosis of a mental illness. Wonder if this will get used a lot or very little?
Subthreshold Depressive Episode with insufficient symptoms
With only a few exclusions everyone now gets to be depressed.
Uncertain Depressive Disorder
This works for anyone else that would like a depression diagnosis but has not yet gotten one.
In my estimation, there will be a lot more people who can qualify for a depressive disorder diagnosis under the new system. I will need to study this one some more before we implement the new DSM-5. This may mean that a lot of people who need help but used to get turned away because they did not meet criteria for a diagnosis will get help. Or it could mean that everyone will get one of the depressive diagnoses and that a Depressive Disorder Diagnosis will stop meaning anything. Only time will tell.
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