Psychiatric diagnosis: the indispensability of ambivalence

By Felicity Callard
J Med Ethics doi:10.1136/medethics-2013-101763

Abstract

The author analyses how debate over the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has tended to privilege certain conceptions of psychiatric diagnosis over others, as well as to polarise positions regarding psychiatric diagnosis. The article aims to muddy the black and white tenor of many discussions regarding psychiatric diagnosis by moving away from the preoccupation with diagnosis as classification and refocusing attention on diagnosis as a temporally and spatially complex, as well as highly mediated process. The article draws on historical, sociological and first-person perspectives regarding psychiatric diagnosis in order to emphasise the conceptual—and potentially ethical—benefits of ambivalence vis-à-vis the achievements and problems of psychiatric diagnosis.

The entire article is here.

The DSM-5: A Vehicle For High-Profit Patent Extensions?

Gregg Fields & Lisa Cosgrove | Labcast
Harvard University SoundCloud Podcast

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders affects drugs with sales in the billions of dollars. In research supported by the Edmond J. Safra Center for Ethics, Lisa Cosgrove of UMass-Boston investigated financial ties between DSM panel members and the pharmaceutical companies that have a vested interest in finding new indications for their blockbuster drugs. In this podcast, she tells journalist Gregg Fields what she found, what it means—and why we all should care.

"Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5," Psychotherapy and Psychosomatics.

ICD-10 and DSM-5: The Reality

Are You Ready For Two Code Sets on October 1?

By Lisette Wright
Behavioral HealthCare
Originally published January 29, 2014

The ICD-10 transition is proving to be a formidable challenge in the healthcare industry for everyone involved. Provider organizations need to train their clinical staff, worry about revenue cycle disruption,  and conduct internal and external testing with all parties. Third-party vendors such as Electronic Health Record companies are also struggling to keep up, with Meaningful Use Stage 2, 2014 Certification, and the ICD-10 transition. Fortunately, there are many trainings available to help you understand the what the ICD-10 transition involves. Unfortunately, most of these trainings are medically-focused, not given by those in the mental health or substance use industry, and they do not really explain how the DSM-5 fits into this transition.

The entire article is here.

Debating DSM-5: diagnosis and the sociology of critique

By Martyn Pickersgill
Journal of Medical Ethics
J Med Ethics doi:10.1136/medethics-2013-101762

Abstract

The development of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance.

The entire article is here.

Ethical Considerations in the Development and Application of Mental and Behavioral Nosologies: Lessons from DSM-5

By Robert M. Gordon and Lisa Cosgrove
Psychological Injury and Law
10.1007/s12207-013-9172-9
December 13, 2013

Abstract

We are not likely to find a diagnostic system as “unethical,” per se, but rather find that it creates ethical concerns in its formulation and application. There is an increased risk of misuse and misunderstanding of the DSM-5 particularly when applied to forensic assessment because of documented problems with reliability and validity. For example, when field tested, the American Psychiatric Association reported diagnostic category kappa levels as acceptable that were far below the standard level of acceptability. The DSM-5 does not offer sensitivity and specificity levels and thus psychologists must keep this in mind when using or teaching this manual. Also, especially in light of concerns about diagnostic inflation, we recommend that psychologists exercise caution when using the DSM-5 in forensic assessments, including civil and criminal cases. Alternatives to the DSM-5, such as the International Classification of Diseases and the Psychodynamic Diagnostic Manual are reviewed.

Here is an excerpt:

It should be emphasized that ethical concerns about DSM-5 panel members having commercial ties is not meant in any way to imply that any task force or work group member intentionally made pro- industry decisions. Decades of research have demonstrated that cognitive biases are commonplace and very difficult to eradicate, and more recent studies suggest that disclosure of financial conflicts of interest may actually worsen bias (Dana & Lowenstein, 2003). This is because bias is most often manifested in subtle ways unbeknownst to the researcher or clinician, and thus is usually implicit and unintentional. Physicians—like everyone else—have ethical blind spots. Social scientists have documented the fact that physicians often fail to recognize their vulnerability to commercial interests because they mistakenly believe that they are immune to marketing and industry influence (Sah & Faugh-Burman, 2013).

The entire article is here.

Lost in the Forest -DSM-V Book Review

By Ian Hacking
London Review of Books
Vol. 35 No. 15 · 8 August 2013
pages 7-8 | 3428 words

The new edition of the DSM replaces DSM-IV, which appeared in 1994. The DSM is the standard – and standardising – work of reference issued by the American Psychiatric Association, but its influence reaches into every nook and cranny of psychiatry, everywhere. Hence its publication has been greeted by a flurry of discussion, hype and hostility across all media, both traditional and social. Most of it has concerned individual diagnoses and the ways they have changed, or haven’t. To invoke the cliché for the first time in my life, most critics attended to the trees (the kinds of disorder recognised in the manual), but few thought about the wood. I want to talk about the object as a whole – about the wood – and will seldom mention particular diagnoses, except when I need an example.

Many worries have already been aired. In mid-May an onslaught was delivered by the Division of Clinical Psychology of the British Psychology Society, which is sceptical about the very project of standardised diagnosis, especially of schizophrenia and bipolar disorders. More generally, it opposes the biomedical model of mental illness, to the exclusion of social conditions and life-course events.

The entire book review is here.

Thanks to Tom Fink for this review.

Biological psychiatry’s false paradigm—still no proof mental illness is a biological disease

By René J. Muller
Baltimore Sun
June 18, 2013

Days before the official May 22 publication date of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), a number of psychiatrists who were closely associated with the project scrambled to do some preemptory damage control, mostly by lowering the expectations for what was to come.

Michael B. First, professor of psychiatry at Columbia, acknowledged on NPR that there was still no empirical method to confirm or rule out any mental illness. “We were hoping and imagining that research would advance at a pace that laboratory tests would have come out. And here we are 20 years later and we still unfortunately rely primarily on symptoms to make our diagnoses.” Speaking to The New York Times, Thomas R. Insel, director of the National Institutes of Mental Health, insisted that this failure had not been for lack of effort.

In the same Times article, David J. Kupfer, chairman of the DSM-5 Task Force, admitted “a failure of our neuroscience and biology to give us the level of diagnostic criteria, a level of sensitivity and specificity that we would be able to introduce into the diagnostic manual.” Drs. Kupfer, Insel and First agree that the new paradigm envisioned for psychiatry — the reason the new edition was undertaken — remains elusive.

The entire article is here.

New Mental-Health Manual Likely to Impact HR

Making accommodations for employees with mental disabilities has never been easy, and it's about to get more difficult with the release of the American Psychiatric Association's new manual of mental disorders.

By James J. McDonald, Jr.
Human Resource Executive Online
Originally published May 22, 2013

In psychiatry, unlike other branches of medicine, there is no laboratory test that can confirm the existence of a particular mental disorder. Psychiatrists and other mental health professionals rely on the Diagnostic and Statistical Manual of Mental Disorders, known as "DSM-5" to diagnose patients. The American Psychiatric Association has just released a new fifth edition of the manual and human resources executives should take note. It contains new diagnostic categories not listed in its predecessor and loosens the criteria for some diagnoses which will likely result in more people qualifying for these diagnoses. DSM-5 is likely to impact HR by expanding the number of employees who will qualify as disabled under the Americans with Disabilities Act and be entitled to reasonable accommodation.

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New Diagnoses

DSM-5 adds several new diagnoses that employers are likely to find vexing. One is "Social (Pragmatic) Communication Disorder," which describes persons whose communication skills are impaired but who do not qualify for an autism diagnosis. It applies to persons with "persistent difficulties in the social use of verbal and nonverbal communications" that limit social relationships or occupational performance. While typically diagnosed in childhood it can continue into adulthood. Employees previously thought to be merely shy or socially awkward may qualify for this new diagnosis.

Another new diagnosis is "Binge Eating Disorder," a condition characterized primarily by eating a large amount of food in a short time at least once per week for three months. DSM-5 notes that while most overweight persons do not engage in recurrent binge-eating, Binge Eating Disorder is "reliably associated with overweight and obesity."  Thus, this diagnosis makes it more likely that obesity (at least when precipitated by binge-eating) might finally qualify as a disability under the ADA.

The entire article is here.

Doctors Protest Psychiatric Manual Revision in Global Petition

By Natasha Khan
Bloomberg News
May 15, 2013

Doctors are protesting new guidance for the diagnosis of some mental disorders, including autism, contained in the revised edition of a professional manual to be released in coming days.

The so-called “psychiatric bible,” whose first update in 19 years will be released at a medical meeting that opens in San Francisco on May 18, also influences the way patients are treated and reimbursed for mental disorders. A petition that raised concerns about the manual’s diagnostic categories and patient safety received more than 3,000 signatures from Paris to Montreal in recent months.

The Diagnostic and Statistical Manual of Mental Disorders is the standard used by mental-health professionals for diagnosing illness and for research. The newest edition is meant to incorporate the latest research findings and has collapsed several conditions, including Asperger’s syndrome and child disintegrative disorder, into a single autism diagnosis.

The entire article is here.

Medicine's big new battleground: does mental illness really exist?

The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis

By Jaime Doward
The Observer
Originally published May 11, 2013

It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.

But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry's dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.

Critics claim that the American Psychiatric Association's increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.

Inevitably such claims have given ammunition to psychiatry's critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.

A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: "Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?"

Psychiatry's supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.

The entire article is here.

DSM-IV Boss Presses Attack on New Revision

By John Gever, Deputy Managing Editor
MedPage Today
Published: May 17, 2013

A new edition of psychiatry's diagnostic guide "will probably lead to substantial false-positive rates and unnecessary treatment," charged the man who led development of the last version.

To be released this weekend at the American Psychiatric Association's annual meeting, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, "introduce[s] several high-prevalence diagnoses at the fuzzy boundary with normality," according to Allen Frances, MD, who chaired the task force responsible for DSM-IV issued in 1994.

Frances, now an emeritus professor at Duke University, wrote online in Annals of Internal Medicine that changes from DSM-IV will apply disease labels to individuals who may be unhappy or offensive but still normal. Such individuals would include those experiencing "the forgetfulness of old age" as well as children with severe, chronic temper tantrums and individuals with physical symptoms with no medical explanation.

He also worried about new marketing pushes from the pharmaceutical industry seeking to exploit what he believes are "loose" diagnostic criteria in the new edition. "Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form," he wrote.

The entire article is here.

New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

By Greg Miller
Wired Science
Originally posted May 17, 2013

Thousands of psychiatrists will descend on San Francisco this weekend for a meeting that will mark the release of the latest edition of the profession’s diagnostic guide, the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. This hugely influential book has been 14 years in the making, and it’s been dogged by controversies every step of the way.

To name just a few, there have been allegations of financial conflicts of interest, debates over whether internet addiction is really a thing (it is not, but “disordered gambling” is), arguments that the new diagnostic criteria will medicalize normal grief and temper tantrums, and lead to millions of people being falsely diagnosed with mental disorders.

With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.


The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

The entire story is here.

Psychiatry’s Guide Is Out of Touch With Science, Experts Say

By PAM BELLUCK and BENEDICT CAREY
The New York Times
Published: May 6, 2013

Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.”

The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

The entire story is here.

Why the Fuss Over the D.S.M.-5?

By Sally Satel
The New York Times - Opinion
Originally published on May 11, 2013

LATER this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion.
      

The charges are familiar: the manual medicalizes garden-variety distress, leads doctors to prescribe unnecessary medications, serves as a cash cow for the association, and so forth.

      

But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.

      

There are dozens of revisions in the D.S.M. — among them, the elimination of a “bereavement exclusion” from major depressive disorder and the creation of binge eating disorder — but they won’t alter clinical practice much, if at all.

      

This is because psychiatrists tend to treat according to symptoms.

      

So why the fuss over D.S.M.-5? Because of the unwarranted clout that its diagnoses carry with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits.

      

This is a problem because the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.

The entire article is here.

CPT and ICD: What Are They? Where Do They Come From?

By Samuel Knapp, EdD, ABPP, Director of Professional Affairs
The Pennsylvania Psychologist
May 2013

The Current Procedural Terminology (or CPT) codes are developed by the American Medical Association (AMA) to ensure a common parlance and unitary language for describing services and procedures by physicians and other health care professionals. The CPT coding manual is copyrighted and published by AMA. CPT I Codes are the five-digit codes used to describe medical procedures; CPT II Codes are supplemental codes used to facilitate data collection about the quality of services provided; and CPT III Codes are for experimental procedures where data is still being gathered. HIPAA requires the standardized use of ICD and CPT codes across insurers. Although CPT codes were widely used before the HIPAA requirement, this HIPAA requirement ended the use of local codes.

A panel of the AMA (the Editorial Panel) creates the CPT codes, although it accepts advice from advisory panels. The Editorial Panel consists of 17 members including 11 physicians nominated by specialty groups within AMA; one physician each from the Blue Cross/Blue Shield Association, America’s Health Insurance Plans (a trade association), the Centers for Medicare and Medicaid Services (CMS), and the American Hospital Association; and two other members from the advisory committees to the Editorial Panel. One of the advisory committees is the Health Care Professional Advisory Committee, which consists of 12 organizations whose members are eligible to use CPT codes (audiologists, chiropractors, registered dieticians, nurses, occupational therapists, optometrists, physical therapists, physician assistants, podiatrists, psychologists, social workers, and speech therapists).

The deliberation process is secret. There is no public comment period for the adoption of these codes and no consumer input. All participants are obligated to follow strict standards of confidentiality, and the punishment for breaking confidentiality is to be removed from the process. The AMA is under no obligation to accept the recommendations of groups impacted by the changes in the CPT codes.

Although the Editorial Panel recommends the particular CPT codes, another committee within AMA, the Relative Value Scale Update Committee (RUC; rhymes with truck) recommends Medicare fees to CMS. The recommendations of RUC are based, to a large extent, on surveys conducted by impacted organizations on the relative work effort involved with the procedure. CMS typically accepts 90% to 100% of the recommendations of the RUC. Often commercial insurers set fees by paying a percentage of what Medicare pays.

Medicare payments are based on the resource-based relative value scale (RBRVS), which consists for three factors: work product, practice expense, and professional liability. Work product involves the time, technical skill, and mental effort required to perform a certain procedure. For physicians as a whole, work product consists of 48%, practice expense consists of 47%, and professional liability insurance consists of 4% of the RBRVS. For psychologists the work product is almost 70% of the RBRVS and professional liability is around 1%. Because the portion of the practice expense component for psychologists is so much lower than for physicians, minor changes in the reimbursement formula can impact psychologists quite differently from physicians.

The American Psychological Association (APA) has a representative on the Heath Care Professional Advisory Committee and had input into revising the CPT codes and the RUC process. Representatives from APA are bound by the very strict standards of confidentiality concerning their participation in the process. I have spoken briefly with APA representatives who can describe their involvement only in general terms. Participation in the process should not be interpreted to mean agreement with the recommendations concerning CPT codes or acceptance of payment.

Diseases are classified according to the ICD (International Classification of Diseases), which was developed by the World Health Organization (an affiliate of the United Nations) to gather information world-wide about the prevalence and incidence of diseases. The United States uses the ICD-cm-9, which means it is the 9th edition of the ICD. The cm refers to “clinical modification,” which is a modification of the ICD for the United States. The rest of the world uses the ICD-10, and the United States will adopt it by October 1, 2014.

Currently, the diagnostic numbers in the DSM-IV correspond to the ICD-9 codes (with a few exceptions). So psychologists can use the DSM-IV coding system and still conform to the ICD-9 system almost all of the time. However, at this time, the coding system in the DSM-V does not correspond to the numbers that would be used in the ICD-10. Although psychologists may wish to learn about the DSM-V as a way to keep abreast of new developments in the area of diagnostics, they will continue to bill only with the ICD-9 (DSM-IV-TR) numerical codes even after the DSM-V is released. Psychologists and other health care professionals will begin coding with the ICD-10 in October 2014.

Transforming Diagnosis

By Thomas Insel on April 29, 2013
NIMH Director’s Blog

In a few weeks, the American Psychiatric Association will release its new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This volume will tweak several current diagnostic categories, from autism spectrum disorders to mood disorders. While many of these changes have been contentious, the final product involves mostly modest alterations of the previous edition, based on new insights emerging from research since 1990 when DSM-IV was published. Sometimes this research recommended new categories (e.g., mood dysregulation disorder) or that previous categories could be dropped (e.g., Asperger’s syndrome).

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.

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That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system.

The entire blog post is here.

Editorial note: The NIMH will no longer use DSM-5 diagnostic criteria.  There have also been numerous criticisms related to DSM-5.  And, given that HIPAA requires ICD diagnostic codes for billing, is there a reason for psychologists to purchase a DSM-5?

Ethical and practical implications of financial conflicts of interest in the DSM-5

By Lisa Cosgrove and Emily Wheeler
doi: 10.1177/0959353512467972
Feminism Psychology
February 2013 vol. 23 no. 1 93-106

Abstract

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in May 2013 by the American Psychiatric Association (APA), has created a firestorm of controversy because of questions about undue industry influence. Specifically, concerns have been raised about financial conflicts of interest between DSM-5 panel members and the pharmaceutical industry. The authors argue that current approaches to the management of these relationships, particularly transparency of them, are insufficient solutions to the problem of industry’s capture of organized psychiatry. The conceptual framework of institutional corruption is used to understand psychiatry’s dependence on the pharmaceutical industry and to identify the epistemic assumptions that ground the DSM’s biopsychiatric discourse. APA’s rationale for including premenstrual dysphoric disorder in the DSM-5 as a Mood Disorder is reviewed and discussed.

Thanks to Ken Pope for sharing this abstract.

Mislabeling Medical Illness

By ALLEN FRANCES, MD
The Health Care Blog
Originally published on February 12, 2013


Many readers of my previous blog listing the 10 worst suggestions in DSM 5 were shocked that I failed to mention an 11th dangerous mistake — that DSM-5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.

Adding to the woes of the medically ill could be one of the biggest problems caused by DSM-5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.

UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM-5. Her website is the best available resource for finding just about everything you need to know about DSM-5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM-5 has gone wrong and the many harmful consequences that will follow. More details are available at: ‘Somatic Symptom Disorder could capture millions more under mental health diagnosis’ (http://wp.me/pKrrB-29B )

Ms Chapman writes:

…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused (‘Somatic Symptom Disorder’ — SSD).

A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.

The entire blog post is here.

Grief Over New Depression Diagnosis

By Paula Span
The New York Time Blog - The New Old Age
Originally published January 24, 2013

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

The entire blog post is here.

Proposed DSM-5 Changes To Assessment Of Alcohol Problems

Medical News Today
Originally posted January 24, 2013

Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD). A second change would remove "legal problems," and a third would add a criterion of "craving." A study of the potential consequences of these changes has found they are unlikely to significantly change the prevalence of diagnoses.

Results will be published in the March 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Updating the DSM could be advantageous if changes are made based on improvements in our understanding of a disorder's etiology, and/or if changes improve the accuracy of the diagnosis," said Alexis C. Edwards, assistant professor in the Department of Psychiatry at Virginia Commonwealth University School of Medicine as well as corresponding author for the study. "It would probably be a little disappointing if no changes were ever made, because that might suggest that we haven't made much headway in understanding and accurately diagnosing psychiatric disorders, despite all our efforts."

The entire story is here.