News / Health

    Revision of Mental Illness Guide Stirs Debate

    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

    Russian-Backed Offensive in Syria Pushes War to Tipping Point

    As threat to Aleppo and rebel forces grows, US plan to negotiate becomes less and less appealing for Syrian government, says one military analyst

    IS Runs Timber Smuggling Business in Afghanistan, Officials Say

    Government turning blind eye to smuggling, according to tribal leaders; Afghanistan's forest cover dropped by 50 percent in three decades, experts say

    Video White House Seeks $1.8 Billion to Combat Zika

    Obama administration says funding would 'support essential strategies to combat the virus' such as rapidly expanding mosquito control programs, accelerating vaccine research

    Featured Videos

    Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
    'No Means No' Program Targets Sexual Violence in Kenyai
    X
    February 08, 2016 4:30 PM
    The organizers of an initiative to reduce and stop rape in the informal settlements around Kenya's capital say their program is having marked success. Girls are taking self-defense classes while the boys are learning how to protect the girls and respect them. Lenny Ruvaga reports from Nairobi.
    Video

    Video 'No Means No' Program Targets Sexual Violence in Kenya

    The organizers of an initiative to reduce and stop rape in the informal settlements around Kenya's capital say their program is having marked success. Girls are taking self-defense classes while the boys are learning how to protect the girls and respect them. Lenny Ruvaga reports from Nairobi.
    Video

    Video New Hampshire Voters Are Independent, Mindful of History

    Once every four years, the northeastern state of New Hampshire becomes the center of the U.S. political universe with its first-in-the-nation presidential primary. What's unusual about New Hampshire is how seriously the voters take their role and the responsibility of being among the first to weigh in on the candidates.
    Video

    Video Chocolate Lovers Get a Sweet History Lesson

    Observed in many countries around the world, Valentine’s Day is sometimes celebrated with chocolate festivals. But at a festival near Washington, the visitors experience a bit more than a sugar rush. They go on a sweet journey through history. VOA’s June Soh takes us to the festival.
    Video

    Video 'Smart' Bandages Could Heal Wounds More Quickly

    Simple bandages are usually seen as the first line of attack in healing small to moderate wounds and burns. But scientists say new synthetic materials with embedded microsensors could turn bandages into a much more valuable tool for emergency physicians. VOA’s George Putic reports.
    Video

    Video Bhutanese Refugees in New Hampshire Closely Watching Primary Election

    They fled their country and lived in refugee camps in neighboring Nepal for decades before being resettled in the northeastern U.S. state of New Hampshire -- now the focus of the U.S. presidential contest. VOA correspondent Aru Pande spoke with members of the Bhutanese community, including new American citizens, about the campaign and the strong anti-immigrant rhetoric of some of the candidates.
    Video

    Video Researchers Use 3-D Printer to Produce Transplantable Body Parts

    Human organ transplants have become fairly common around the world in the past few decades. Researchers at various universities are coordinating their efforts to find solutions -- including teams at the University of Pennsylvania and Rice University in Houston that are experimenting with a 3-D printer -- to make blood vessels and other structures for implant. As VOA’s Greg Flakus reports from Houston, they are also using these artificial body parts to seek ways of defeating cancerous tumors.
    Video

    Video Helping the Blind 'See' Great Art

    There are 285 million blind and visually impaired people in the world who are unable to enjoy visual art at a museum. One New York photographer is trying to fix this situation by making tangible copies of the world’s masterpieces. VOA correspondent Victoria Kupchinetsky was there as visually impaired people got a feel for great art. Joy Wagner narrates her report.
    Video

    Video Sanders, Clinton Battle for Young Democratic Vote

    Despite a narrow loss to former Secretary of State Hillary Clinton in last week's Iowa Democratic caucuses, Vermont Senator Bernie Sanders secured more than 80 percent of the vote among those between the ages of 18 and 29. VOA correspondent Aru Pande talks to Democrats in New Hampshire about who they are leaning towards and why in this week's primary.
    Video

    Video German Artists to Memorialize Refugees With Life Jacket Exhibit

    Sold in every kind of shop in some Turkish port towns, life jackets have become a symbol of the refugee crisis that brought a million people to Europe in 2015.  On the shores of Lesbos, Greece, German artists collect discarded life jackets as they prepare an art installation they plan to display in Germany.  For VOA, Hamada Elrasam has this report from Lesbos, Greece.
    Video

    Video E-readers Help Ease Africa's Book Shortage

    Millions of people in Africa can't read, and there's a chronic shortage of books. A non-profit organization called Worldreader is trying to help change all that one e-reader at a time. VOA’s Deborah Block tells us about a girls' school in Nairobi, Kenya where Worldreader is making a difference.
    Video

    Video Genius Lets World Share Its Knowledge

    Inspired by crowdsourcing companies like Wikipedia, Genius allows anyone to edit anything on the web, using its web annotation tool
    Video

    Video In Philippines, Mixed Feelings About Greater US Military Presence

    In the Philippines, some who will be directly affected by a recent Supreme Court decision clearing the way for more United States troop visits are having mixed reactions.  The increased rotations come at a time when the Philippines is trying to build up its military in the face of growing maritime assertiveness from China.  From Bahile, Palawan on the coast of the South China Sea, Simone Orendain has this story.
    Video

    Video Microcephaly's Connection to Zika: Guilty Until Proven Innocent

    The Zika virus rarely causes problems for the people who get it, but it seems to be having a devastating impact on babies whose mothers are infected with Zika. VOA's Carol Pearson has more.
    Video

    Video Stunning Artworks Attract Record Crowds, Thanks to Social Media

    A new exhibit at the oldest art museum in America is shattering attendance records. Thousands of visitors are lining up to see nine giant works of art that have gotten a much-deserved shot of viral marketing. The 150-year-old Smithsonian American Art Museum has never had a response quite like this. VOA's Julie Taboh reports.