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Rundown on DSM-V Evolution

It's scheduled to come out in May 2013, and this doc (Allen Frances, MD) asks the question: is the APA going to release it because it is needed and helpful and founded for psychiatric treatment? Or because they want the income from the release of a new book?? He has a good grasp on where the system fails and what needs to happen next. He'd like to see changes based in science, and is keenly aware of the degree to which psych diagnosis is inexact and the pathophysiology of these diseases uncertain.

You have to create a login to read here:
http://www.medscape.com/viewarticle/763886?src=mp&spon=38

Here are his concerns that the current DSM-IV does not deal with:
20x autism rates (is everybody really autistic??)
20x childhood bipolar rates
3x ADHD rates
2x adult bipolar rates
"Misuse of the label "paraphilia NOS" to sanction the questionably constitutional involuntary commitment of rapists as a veiled form of preventive detention"

And here are the things he is worried will be stuffed prematurely into the DSM-V:
Disruptive mood dysregulation disorder
Minor neurocognitive disorder
Removing the bereavement exclusion for major depressive disorder (sadness not allowed!)
Lowered ADHD threshold (by raising the allowed age of onset to 12) (how does this work??)
Lowered threshold and poor reliability for generalized anxiety disorder
Combining substance abuse w substance dependence under "addictive disorders" (low reliability and unnecessary stigma)
A category for "behavioral addictions" that will promote "Internet addiction" as a NOS diagnosis. (Next: "addictions" to sex, shopping, work, golf, boating)
Pedophilia criteria wording that tries to sneak in hebephilia (preference for early pubescent teens) and invites forensic abuse
Making binge-eating a mental disorder
An unusable personality section that the APA Assembly voted unanimously to oppose

Comments

( 4 comments — Leave a comment )
newedition
Jun. 7th, 2012 04:33 pm (UTC)
Great quote from the article:
"Each disorder in the DSM is probably just a final common presentation caused by hundreds of different and heterogeneous biological pathways."
I think this is true of a lot of the complex physical conditions as well, such as chronic fatigue and fibromyalgia. Fatigue, aches, pains, etc. can be caused by anemia, hypothyroidism, and probably 100 other reasons, but until the patient gets that specific diagnosis, he/she is just lumped in as having "fatigue."

Psychiatric disorder labels are troublesome to me. There certainly are emotional and behavior disturbances due to bad philosophy, lack of motivation, bad habits, lack of coping skills, cultural influences, etc. There are also emotional and behavior disturbances due to biology-- and I'd suspect most childhood or adolescent-onset so-called psychiatric disorders fall into this category. They are physical diseases with brain manifestations. Even vitamin deficiencies can cause mental symptoms. The trouble is, that seems to point toward determinism. :-/

Regarding binge eating as a disorder-- in some cases I think it is, though I think it's biochemical rather than emotional. You're probably well-versed in the Ancel Keys starvation experiments. After restricted caloric intake over a period of time, the starved subjects developed tremendous cravings and uncontrollable bingeing that lasted for months, if not years, after they were allowed to resume normal meals. Interestingly, the starvation level was 1,200 calories a day, which is what many modern Americans subject themselves to when dieting. There are some theories that say binge eating disorder is a compensatory response for previous undernutrition.
liveonearth
Jun. 7th, 2012 04:37 pm (UTC)
LOL. Binge eating has a zillion etiologies not the least of which is insulin and leptin dysregulation due to poor diet. Psych disorders are inextricably intertwined with metabolic disorders. Such is the life of an organism of complexity. Would life be better as a single celled organism? I think not...
b_vainamoinen
Jun. 8th, 2012 10:16 pm (UTC)
I'm not thrilled with grief getting added to the DSM.

What is this going to do to hospice programs who have to keep in touch with the families for 12 months after the death of the patient? Are they going to have to hire licensed counseling staff now to do that? At present - hospice staff who work in bereavement do not have to have any kind of mental health certification. Mainly because the people who are grieving are NOT MENTALLY ILL!
liveonearth
Jun. 9th, 2012 07:18 pm (UTC)
Yeah, me neither. What this means is that psychiatrists will have backing for medicating people who are grieving. Up to now it has been OK to let people who've lost a dear one be sad...
( 4 comments — Leave a comment )

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