News / Health

Revision of Mental Illness Guide Stirs Debate

TEXT SIZE - +
Jessica Berman
A long-anticipated revision of an official diagnostic guide to mental illness, known as the DSM-5, was released this week.  While the new manual is being welcomed by some doctors as reflecting advancements in the understanding and diagnosis of mental disorders, critics say its definitions of psychiatric conditions are based too much on symptoms and too little on the biological causes of mental illness.

The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is considered by many psychiatrists and psychologists to be the “bible” by which they can diagnose and treat their patients' mental illnesses.
 
It’s been nearly 20 years since the DSM's publisher, the American Psychiatric Association, or APA, did a major revision of the voluminous guide.

David Kupfer, a professor of psychiatry at the University of Pittsburgh in Pennsylvania, headed the international task force that put together this fifth version of the DSM.  Kupfer says it was time to update the manual, a process that took the task force a decade to complete.

“We are quite excited about putting out DSM-5 as a revision due to the fact that many things have happened over the last 19 years; that it was felt, in terms of scientific evidence that we were ready for a change,” Kupfer said.

For example, the manual drops the separate diagnosis of Asperger’s syndrome, a developmental disorder marked by significant difficulties with social interaction, and folds it into a broader category called autism spectrum disorders.
 
Asperger’s is considered the mildest form of autism, which can cause an inability to communicate with others, emotional outbursts and repetitive behaviors.

Kupfer believes that the change in the Asperger’s designation is relatively minor. But Alycia Halladay, a senior director of Autism Speaks, an advocacy group for people with autism, thinks otherwise.  Halladay says people who were previously diagnosed with Asperger’s will still have access to special treatment and training programs in the U.S.

“We’re concerned about individuals who may have shown symptoms of Asperger’s or may show symptoms of what was called Asperger’s not meeting the criteria for what is now called autism. And therefore not receiving services,” Halladay said.

Another significant change in DSM-5 that critics have targeted is its revised definition of depression.  The old criteria were that a patient had to display symptoms of unhappiness or lack of pleasure for weeks or months at a time.  

Now, the manual specifies that a psychiatrist may diagnose a patient with clinical depression after just two weeks of persistent sadness.

“[To] Diagnose major depression after a bereavement is medicalizing a normal human reaction, that is the grief of losing a loved one,” explained Bruce Cuthbert, coordinator of the US National Institute of Mental Health’s Research Domain Criteria Project or RDoC.  RDoC is tasked with pulling together the latest research identifying the biological underpinnings of mental disorders such as depression and schizophrenia.

Cuthbert says the DSM-5 continues the prevailing symptoms-based approach to the diagnosis and treatment of patients with psychiatric disorders.  It's an approach he calls “hit or miss” since the drugs and therapies prescribed to relieve a mental health condition don't always work as hoped.  As a result, Cuthbert says, doctors frequently resort to trying different medications on the same patient.  

Cuthbert says mental health research also tends to follow definitions outlined in the DSM manual.

“That’s what we need to change, because we know that these categories are very complicated.  There are many different mechanisms of brain functioning and behavior that are involved with any one of these disorders,” Cuthbert said.

As scientific research sheds new light on the biological causes of mental illness, Cuthbert says doctors will be able to target increasingly effective treatments for their patients' psychiatric disorders.  Experts say those advances will be incorporated by the American Psychiatric Association in future revisions to its DSM.

You May Like

Video Pope Francis Hopes Dual Canonizations Will Reconcile Church

John the XXIII and John Paul II will be made saints in a ceremony at St. Peter’s Square on April 27 More

Thailand Reacts to Plots Targeting Israelis

Authorities hope arrest of two Lebanese suspects will disrupt plot to attack young Israeli tourists More

Video In Capturing Nature's Majesty, Film Makes Case for Its Survival

'Once Upon a Forest' takes viewers deep into heart of tropical rainforest More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Pope Francis Hopes Dual Canonizations Will Reconcile Churchi
|| 0:00:00
...
 
🔇
X
Jerome Socolovsky
April 22, 2014 4:14 PM
On April 27, two popes - John the XXIII and John Paul II - will be made saints in a ceremony at St. Peter’s Square. VOA religion correspondent Jerome Socolovsky says the dual canonization is part of the current pope’s program to reconcile liberals and conservatives in the Roman Catholic Church.
Video

Video Pope Francis Hopes Dual Canonizations Will Reconcile Church

On April 27, two popes - John the XXIII and John Paul II - will be made saints in a ceremony at St. Peter’s Square. VOA religion correspondent Jerome Socolovsky says the dual canonization is part of the current pope’s program to reconcile liberals and conservatives in the Roman Catholic Church.
Video

Video In Capturing Nature's Majesty, Film Makes Case for Its Survival

French filmmaker Luc Jacquet won worldwide acclaim for his 2005 Academy Award-winning documentary "March of the Penguins". Now Jacquet is back with a new film that takes movie-goers deep into the heart of a tropical rainforest - not only to celebrate its grandeur, but to make the case for its survival. VOA's Rosanne Skirble reports.
Video

Video Boston Marathon Bittersweet for Many Runners

Monday's running of the Boston Marathon was bittersweet for many of the 36,000 participants as they finished the run that was interrupted by a double bombing last year. Many gathered along the route paid respect to the four people killed as a result of two bombings near the finish line. VOA's Carolyn Presutti returned to Boston this year to follow two runners, forever changed because of the crimes.
Video

Video Pacific Rim Trade Deal Proves Elusive

With the U.S.-led war in Iraq ended and American military involvement in Afghanistan winding down, President Barack Obama has sought to pivot the country's foreign policy focus towards Asia. One aspect of that pivot is the negotiation of a free-trade agreement among 12 Pacific Rim nations. But as Obama leaves this week on a trip to four Asian countries he has found it very difficult to complete the trade pact. VOA's Ken Bredemeier has more from Washington.
Video

Video Robotic Mission Kicks Up Lunar Dust

A robotic mission to the moon was deliberately crashed onto the lunar surface late last week, but not before scientists had collected data gathered by the spacecraft which was designed to self-destruct. VOA's Rosanne Skirble reports on the preliminary findings of the craft, called LADEE - an acronym for Lunar Atmosphere and Dust Environment Explorer.
Video

Video Boko Haram Claims Responsibility for Bombing in Nigerian Capital

The Nigerian militant group known as Boko Haram has claimed responsibility for a bombing in the capital on April 14th that killed 75 people. In the video message, Abubakar Shekau, the man who says he ordered the bombing, says nothing about the mass abduction of more than 100 teenage girls, most of whom are still missing. Heather Murdock has more for VOA from Abuja.
Video

Video Ukraine Developments Hang Over Obama Trip to Asia

President Barack Obama's trip to Asia this week comes as concerns over Beijing's territorial ambitions are growing in the region. Those concerns have been compounded by Russia's recent actions in Ukraine and the possibility that Chinese strategists might be looking to Crimea as a model for its territorial disputes with its neighbors. VOA's Bill Ide has more from Beijing.
Video

Video Autistic Adults Face Housing, Job Challenges

Many parents of children with disabilities fear for the future of their adult child. It can be difficult to find services to help adults with disabilities - physical, mental or emotional - find work or live on their own. The mother of an autistic boy set up a foundation to advocate for the estimated 1.2 million American adults with autism, a developmental disorder that causes communication difficulties and often social difficulties. VOA's Faiza Elmasry reports.
AppleAndroid