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APA approves DSM-5
The American Psychiatric Association Board of Trustees has approved the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the association announced in a statement. The DSM-5 is set to be published in May 2013.
“The Board of Trustees approval of the criteria is a vote of confidence for DSM-5,” APA president Dilip Jeste, MD, said in a press release. “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.”
According to the APA, the new edition will include approximately the same number of disorders as its predecessor, the DSM-IV. The manual will have three sections; an introduction explaining how to use the updated version, an outline of the categorical diagnoses, and a section devoted to conditions that require further research before they are included as recognized disorders — these will include attenuated psychosis syndrome, internet use gambling disorder, nonsuicidal self-injury and suicidal behavioral disorder. The DSM-5’s 20 chapters will be reorganized based on how disorders relate to one another according to symptom characteristics.
Some of the revisions in the DSM-5 include the following:
- Autism spectrum disorder (ASD) will encompass a number of diagnoses from the DSM-IV, including Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified.
- Binge eating disorder will be recognized.
- Disruptive mood dysregulation disorder will be included to diagnose children aged 6 years or more who exhibit frequent outbursts of anger and persistent irritability.
- Hoarding disorder will be recognized.
- Bereavement will be excluded from the major depression section.
- Posttraumatic stress disorder will belong to a new chapter on Trauma- and Stressor-Related Disorders.
- Substance use and substance dependence will combine to form the single category of substance use disorder.
Some groups have expressed concern over the approved changes. Geraldine Dawson, PhD, chief science officer of the advocacy group Autism Speaks, said collapsing autism subtypes into a single category will impact how clinicians diagnose ASD in their patients, but that her group ultimately supports the APA’s decision.
“We are reassured that the DSM-5 committee has stated that all individuals who currently have a diagnosis on the autism spectrum, including those with Asperger['s] syndrome, will be able to retain an ASD diagnosis,” Dawson said. “This means that no one with a current diagnosis on the autism spectrum should ‘lose’ their diagnosis because of the changes in diagnostic criteria. Also, the committee has stressed that the new DSM-5 criteria represent a ‘living document,’ in which changes can and likely will be made as new studies are conducted.”
David J. Kupfer, MD, chair of the DSM-5 Task Force, said the work groups involved in the revision of the manual have focused on creating a text that will ultimately help patients.
“We have sought to be conservative in our approach to revising DSM-5,” Kupfer said. “Our work has been aimed at more accurately defining mental disorders that have a real impact on people’s lives, not expanding the scope of psychiatry. I’m thrilled to have the Board of Trustees’ support for the revisions and for us to move forward toward the publication.”
Perspective
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We’ve been working on this for five years... The DSM-5 is pretty much what was proposed by the work groups for the most part. You never get every detail or every issue addressed, but I think what we did was useful and will be helpful and will carry us forward. We would have like to have done more, but we were limited to the data that was available. I think overall we did pretty well given the standards we were held to.
The intention — and it’s not quite clear how this will be done, yet — is that this be a living document. That’s why they use the Arabic “5” in the name, because there will probably be a 5.1 and a 5.2. The philosophy they were trying to imbue here is that it’s not a static thing, and as new findings come in, there may be need for further changes. And, so, the idea is to make it a more fluid document. How that will play out, we’ll have to see.