New Diagnostic Guidelines for DSM: The Manual for Mental Disorders

New Diagnostic Guidelines for Mental Illnesses Proposed - BusinessWeek

For the first time in more than a decade, the American Psychiatric Association has announced proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM), long considered the "Bible" of psychiatry.

Unlike its predecessor, DSM-4, the new DSM-5 would not formally recognize sex and Internet addictions; would create a new category for "risk" disorders for people possibly heading towards developing full psychosis or dementia; and would create a new disorder, "temper dysregulation with dysphoria" (TDD) to incorporate both mood and behavioral disturbances, partly a response to current overdiagnosis of juvenile bipolar disorder.

Other issues were also addressed, including creating an overarching category known as "autism spectrum disorders" to encompass autism, Asperger's syndrome and other similar conditions. This term is already widely used. And "mental retardation" would become "intellectually challenged."

DSM is the tome used by psychiatrists and other mental health professionals to diagnose different conditions and to guide research.

The proposed draft will be available for public comment until April 20. The final document, which has already been 10 years in the making, is expected to be released in 2013. The DSM-4 was published in 1994.

One of the major changes in the proposed volume will be a move toward "dimensional assessments" for mental disorders, meaning that strict, immutable categories will be replaced by a reliance on continuums and that "cross-cutting" symptoms -- those that span several different disorders -- will be included in the criteria.

"There's no measure in the [DSM-4] to account for the severity of the disorder and therefore no way to measure if a patient, on quantitative measures, is improving with treatment," Dr. Darrel Regier, vice chair of the DSM-5 Task Force and director of research for the American Psychiatric Association, said during a Tuesday teleconference announcing the proposed changes. "We're trying to address this with more quantitative measures on a continuum with a cut-off to decide mild, severe, very severe."

This time around, experts say they are giving "careful consideration" to how mental health disorders might vary according to race, gender and ethnicity.