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

Video One Year After Thai Coup, No End in Sight for Military Rule

Since carrying out the May 22, 2014 coup, the general has retired from the military but is still firmly in charge More

Goodbye, New York

This is what the fastest-growing big cities in America have in common More

Job-Seeking Bangladeshis Risk Lives to Find Work

The number of Bangladeshi migrants on smugglers’ boats bound for Southeast Asian countries has soared in the past two years More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Turkey's Main Opposition Party Hopes for Election Breakthroughi
X
May 22, 2015 10:23 AM
Turkey’s main opposition Republican People’s Party has sought an image change ahead of the June 7 general election. The move comes after suffering successive defeats at the hands of the Islamist-rooted AK Party, which has portrayed it as hostile to religion. Dorian Jones reports from the western city of Izmir.
Video

Video Turkey's Main Opposition Party Hopes for Election Breakthrough

Turkey’s main opposition Republican People’s Party has sought an image change ahead of the June 7 general election. The move comes after suffering successive defeats at the hands of the Islamist-rooted AK Party, which has portrayed it as hostile to religion. Dorian Jones reports from the western city of Izmir.
Video

Video Europe Follows US Lead in Tackling ‘Conflict Minerals’

Metals mined from conflict zones in places like the Democratic Republic of Congo are often sold by warlords to buy weapons. This week European lawmakers voted to force manufacturers to prove that their supply chains are not inadvertently fueling conflicts and human rights abuses. Henry Ridgwell reports from London.
Video

Video Class Tackles Questions of Race, Discrimination

Unrest in some U.S. cities is more than just a trending news item at Ladue Middle School in St. Louis, Missouri. As VOA’s Kane Farabaugh reports, it’s a focus of a multicultural studies class engaging students in wide-ranging discussions about racial tensions and police aggression.
Video

Video Mind-Controlled Prosthetics Are Getting Closer

Scientists and engineers are making substantial advances towards the ultimate goal in prosthetics – creation of limbs that can be controlled by the wearer’s mind. Thanks to sophisticated sensors capable of picking up the brain’s signals, an amputee in Iceland is literally bringing us one step closer to that goal. VOA’s George Putic reports.
Video

Video Afghan Economy Sinks As Foreign Troops Depart

As international troops prepare to leave Afghanistan, and many foreign aid groups follow, Afghans are grappling with how the exodus will affect the country's fragile economy. Ayesha Tanzeem reports from the Afghan capital, Kabul.
Video

Video Poverty, Ignorance Force Underage Girls Into Marriage

The recent marriage of a 17-year old Chechen girl to a local police chief who was 30 years older and already had a wife caused an outcry in Russia and beyond. The bride was reportedly forced to marry and her parents were intimidated into giving their consent. The union spotlighted yet again the plight of many underage girls in developing countries. Zlatica Hoke reports poverty, ignorance and fear are behind the practice, especially in Asia and Africa.
Video

Video South Korea Marks Gwangju Uprising Anniversary

South Korea this week marked the 35th anniversary of a protest that turned deadly. The Gwangju Uprising is credited with starting the country’s democratic revolution after it was violently quelled by South Korea’s former military rulers. But as Jason Strother reports, some observers worry that democracy has recently been eroded.
Video

Video California’s Water System Not Created To Handle Current Drought

The drought in California is moving into its fourth year. While the state's governor is mandating a reduction in urban water use, most of the water used in California is for agriculture. But both city dwellers and farmers are feeling the impact of the drought. Some experts say the state’s water system was not created to handle long periods of drought. Elizabeth Lee reports from Ventura County, an agricultural region just northwest of Los Angeles.
Video

Video How to Clone a Mammoth: The Science of De-Extinction

An international team of scientists has sequenced the complete genome of the woolly mammoth. Led by the Swedish Museum of Natural History in Stockholm, the work opens the door to recreate the huge herbivore, which last roamed the Earth 4,000 years ago. VOA’s Rosanne Skirble considers the science of de-extinction and its place on the planet
Video

Video Blind Boy Defines His Life with Music

Cole Moran was born blind. He also has cognitive delays and other birth defects. He has to learn everything by ear. Nevertheless, the 12-year-old has had an insatiable love for music since he was born. VOA’s June Soh introduces us to the young phenomenal harmonica player.

VOA Blogs