Diagnostic and Statistical Manual V: Small Changes with Big Implications

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What will be the implications of the DSM-V? Image by Digital Shotgun

The Diagnostic and Statistical Manual, or DSM, is being updated again.

The American Psychiatric Association’s timeline calls for the “Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc..” in December of 2012.

This edition, the fifth, attempts to further define what is, and what is not, a mental disorder.

What symptoms are included, what they are named, and who will escape labeling all become problematic… and political.

While the addition of binge eating appears to be somewhat neutral, and perhaps overdue, and the folding of Asperger’s syndrome into the autism spectrum may be based purely on brain science, other proposed changes are more nuanced.

Dependence to Become Addiction?

According to Recovery Today Online, one major anticipated change in the new DSM-V will eliminate the category of “substance abuse and dependence” and replace it with “addictions and related disorders.”   While the difference may seem semantic, the intent is to clarify that withdrawal is a normal response to the discontinuance of some medications, “whereas addiction is compulsive-drug seeking behavior.”  The emphasis would now be on the behavior, rather than the physical response.

Ironically, in a year when marijuana use has gained new legal acceptance, new criteria is suggested for cannabis withdrawal. 

Gender Identity Disorder to Become Gender Dysphoria?

In what could be seen as a political move, the DSM-V is expected to focus more on the unhappiness that gender identity problems may cause rather than the issue of gender identity itself.  Everyday Health notes that it is problematic if psychiatry “casts one’s identity as an illness.”  Focusing on emotional, rather than a state of being, appears to address this issue.

Women will be affected by the proposed changes. Image by thisreidwrites

Implications for Women

Some of the proposed changes have a disproportionate impact on women.  Men would be unlikely to be diagnosed with the newly proposed “premenstrual dysphoric disorder.” As with gender dysphoria, the intent appears to be to focus on the emotions associated with PMS rather than menstruation itself.

Proposed upgrades to the personality disorders category are heartening.  Women were frequently diagnosed as “histrionic” a personality disorder that is slated for deletion.  The “disorder” included many criteria such as shallow relationships, focus on self, over dramatization and seductiveness.

Additional Proposed Disorders for the DSM-V

Hoarding and binge eating have been on the scene for a while.  Originally considered a type of OCD (obsessive-compulsive disorder) hoarding is understood to have distinct features. Binge eating, once only in the appendix of the DSM-IV will most likely be added to same category as anorexia.  Children will no longer be bi-polar, but could instead be categorized as having “disruptive mood regulation disorder” to distinguish their issues from adult bi-polar disorder, which may keep children from being mislabeled and potentially, inappropriately medicated.  Other changes, such as the elimination of “metal retardation” in favor of “intellectual developmental disorder” appear to be kinder and gentler.

Changes in Mental Disorder Labeling

At the end of the month, the final version will be submitted for printing in May of 2013.  Women, children, the intellectually challenged, and those who identify with both genders appear to be poised to be the winners of this round.

Sources:

Curley, B. DSM-V-Major Changes to Addictive Disease Classifications: Recovery Online Today. (2012). Accessed December 1, 2012.

American Psychiatric Association. DSM-V Development-Timeline(2012). Accessed December 1, 2012.

Hiss, K. 14 Big Changes in ‘The Psychiatrist’s Bible’: Everyday Health(2012) Accessed December 1, 2012.

Healthy Place. Histrionic Personality Disorder(2012). Accessed December 1, 2012.

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