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Psychiatrists rewriting the mental health bible

The Diagnostic and Statistical Manual of Mental Disorders, commonly called DSM, is getting an update. Now experts must decide what is a disorder and what falls in the range of normal human behavior.

May 26, 2009|Shari Roan

Also, mood disorders range widely from mild to severe, said Dr. Jan Fawcett, chairman of the mood disorders work group, one of 13 committees on the task force. A person with four of the nine listed symptoms for depressive disorder can be more troubled and disabled than another person with six of the nine symptoms.

"We don't want to take everyone who is demoralized by life and call it depression," he said. "But we also don't want to miss something."

Attention to finer shades will also help doctors and therapists recognize disorders in their earliest stages, when they are mild and easier to treat or prevent. Psychiatrists are especially interested in identifying prodromal forms, or earliest symptoms, of conditions such as bipolar disorder, schizophrenia and dementia, said Dr. William Carpenter Jr., psychiatry professor at the University of Maryland and chairman of the psychotic disorders work group.

Other changes simply reflect modern times, with obesity, for example, potentially to be labeled as a symptom of, or risk factor for, a mental disorder. This, among other things, may help doctors address a growing controversy on whether candidates for bariatric surgery are being adequately screened for their psychological health before they undergo the procedure.

"We know obesity is a risk factor for physical disorders and is probably a risk factor for psychiatric disorders too," Kupfer said. "The work group has spent time on what to do with obesity in DSM-V."

Gambling, sex addiction and Internet addiction -- formerly dismissed as harmful habits that could be defeated with willpower -- may also be labeled illnesses.

"It isn't a question of whether these things are real," Kupfer said. "They are. The question is whether there is enough empirical evidence to meet the threshold."

Leaders of the APA acknowledge the controversial nature of some of their discussions and have posted recent progress reports on the association's website, www.dsm5.org.

The meeting may have ended Thursday, but debates, revisions and studies are slated to last for 18 more months. And the new edition won't land on psychiatrists' desks with a note saying, "See you in 15 years." Task force members say it will be updated frequently.

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shari.roan@latimes.com

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