New changes are in the works for the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is sometimes referred to as the "psychiatrist's bible." The American Psychiatric Association (APA), which publishes the manual, placed a draft of the publication online this week and will seek comments on the draft through April 20.
"These draft criteria represent a decade of work by the APA in reviewing and revising DSM," said APA President Alan Schatzberg, MD, in a statement releasing the publication. "But it is important to note that DSM 5 is still very much a work in progress—and these proposed revisions are by no means final."
Members of 13 work groups, representing different categories of psychiatric diagnoses, have reviewed a wide body of scientific research in the field and proposed numerous revisions to the current DSM. They include:
- Recommending new categories for learning disorders and a single diagnostic category—"autism spectrum disorders"—that will incorporate the current diagnoses of autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified).
- Recommending that the diagnostic term "mental retardation" be changed to "intellectual disability," bringing the DSM criteria into alignment with terminology used by other disciplines.
- Eliminating the current categories of substance abuse and dependence, and replacing them with the new category "addiction and related disorders."
- Creating a new category of "behavioral addictions," in which gambling will be the sole disorder.
- Adding new "suicide scales" for adults and adolescents to help clinicians identify those individuals most at risk, with a goal of improving interventions; the scales include research based criteria, such as impulsive behavior and heavy drinking in teens.
- Adding a new diagnostic category, temper dysregulation with dysphoria (TDD), within the mood disorders section of the manual to assist clinicians when differentiating children with these symptoms from those with bipolar.
- Recognizing binge eating disorders and including improved criteria for anorexia nervosa and bulimia nervosa, as well as recommended changes in the definitions of some eating disorders.
Following review of the public comments, the draft will be refined over the next two years. The APA will conduct three phases of field trials to test some of the proposed diagnostic criteria in real world clinical settings. The last edition of the DSM was published in 1994.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at firstname.lastname@example.org