That big fat bible of psychiatric diagnosis — the DSM — is one step closer to its overhaul, a task that has taken more than a decade. On Dec. 1, the board of trustees of the American Psychiatric Assn. voted to approve the fifth edition of the book, which psychiatrists use to diagnose patients. The final edition is due out in May.
Among the changes:
- Asperger’s disorder will no longer be classed as a separate condition but will be folded into an umbrella category called autism spectrum disorder.
- Hoarding disorder is added to the book.
- “Disruptive mood dysregulation disorder” is a new psychiatric category for children and adolescents who exhibit “persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.” Many such kids are today diagnosed with — and then medicated for — bipolar disorder, which is an issue of concern to many who work in mental health.
- Identifying as transgender will no longer be listed as “gender identity disorder.” The term is replaced by “gender dysphoria,” which would refer to “emotional distress over a marked incongruence between one's experienced/expressed gender and assigned gender.” The distress is the focus, in other words, not the state of being. Many within the transgender community support this de-pathologizing, though some note it might make it harder for people who identify as transgender to receive medical services, as this article discusses.
- People suffering grief had in the past been excluded for a diagnosis of depression during a certain window of time: Grief, after all, is a natural reaction to loss. That "grief exclusion" is out. The change “reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate and major depressive episode beginning soon after the loss of a loved on,” the APA statement explains.
- Hypersexual disorder — what’s popularly termed sex addiction — did not make it into DSM-5, though its inclusion had been debated.
“We developed DSM-5 by utilizing the best experts in the field and extensive reviews of the scientific literature and original research, and we have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve,” said Dr. Dilip Jeste, the psychiatric association’s president, in a release you can read on the DSM-5 website.