Psychiatrists unveil their long-awaited diagnostic "bible"

Fri May 17, 2013 12:05am EDT
Email This Article |
Share This Article
  • Facebook
  • LinkedIn
  • Twitter
| Print This Article | Single Page
[-] Text [+]

By Sharon Begley

NEW YORK (Reuters) - The long-awaited, controversial new edition of the bible of psychiatry can be characterized by many numbers: its 947 pages, its $199 price tag, its more than 300 maladies (from "dependent personality disorder" and "voyeuristic disorder" to "delayed ejaculation," "kleptomania" and "intermittent explosive disorder"), each limning the potential woes of being human.

But to the psychiatrist who shepherded the tortuous creation of the "Diagnostic and Statistical Manual of Mental Disorders," perhaps the single most important number is the "5" in its title: This is the DSM-5, not the DSM-V.

That may seem like a cosmetic change, but the American Psychiatric Association, which will release the book on Saturday at its annual meeting, decided to use Arabic instead of Roman numerals because "we want it to be a living document," said Dr David Kupfer of the University of Pittsburgh, the chairman of the task force that produced the DSM-5. Rather than waiting another generation to revise the manual - the DSM-IV was published in 1994 - psychiatrists will regularly update it with, for example, findings from genetics and neuroscience, labeling the revisions DSM-5.1 and DSM-5.2 and so on.

"We used '5' because V.0 and V.1 just don't look good," said Kupfer.

The fact that the world's most powerful psychiatrists (their decisions determine what counts as a mental disorder, and thus what insurers cover and which children receive special services in school) are already building in ways to change the manual is commendable, even its critics say.

But it is also emblematic of the DSM-5's failures, they argue, which include turning normal human behavior and feelings into mental illnesses, and expanding the criteria for disorders until an astonishing one in four U.S. adults has a diagnosable mental illness every year - and even more do over a lifetime.

The latest revision began in 1999 with high hopes for putting mental illness on a scientific footing, using neuroscience in particular to tell the difference between, say, normal sadness and major depression.

That reflected persistent criticism that "drawing a line between sickness and disease is a special problem in psychiatry," said psychotherapist Gary Greenberg, who participated in the "field trials" that tested the DSM-5's proposed diagnostic criteria before they made the final cut. "We don't have blood tests or other objective criteria to distinguish mental sickness from health. So you have a set of criteria that are very common, which means the potential for many people being diagnosed as mentally ill when they're not."   Continued...