Doctors may alter psychiatric diagnoses

The Seattle Times Company

Originally published Tuesday, February 9, 2010 at 10:01 PM

Doctors may alter psychiatric diagnoses
The American Psychiatric Association is proposing major changes Wednesday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat.

By LAURAN NEERGAARD

The Associated Press

WASHINGTON — Don't say "mental retardation" — the new term is "intellectual disability." No more diagnoses of Asperger's syndrome — call it a mild version of autism instead. And while "behavioral addictions" will be new to doctors' dictionaries, "Internet addiction" didn't make the cut.

The American Psychiatric Association (APA) is proposing major changes Wednesday to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them.

The manual suggests some new diagnoses. So far, gambling is the lone identified behavioral addiction, but in the new category of learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don't purge.

Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders — such as dementia or schizophrenia — based on early symptoms, even though there's no way to know who will worsen into full-blown illness. It's a category the psychiatrist group's own leaders say must be used with caution because scientists don't yet have treatments to lower that risk but also don't want to miss people on the cusp of needing care.

Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

But overall the manual's biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses — and urge doctors to concentrate more on the severity of their patients' symptoms.

The psychiatric group expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.

"Is someone really a patient, or just meets some criteria like trouble sleeping?" said APA President Dr. Alan Schatzberg, a Stanford University psychiatry professor. "It's really important for us as a field to try not to overdiagnose."

The update of this manual called the DSM-5 — the Diagnostic and Statistical Manual of Mental Disorders, fifth edition — is the first update since 1994, and brain research during that time period has soared.

That work is key to give scientists new insight into mental disorders with underlying causes that often are a mystery and that cannot be diagnosed with, say, a blood test or X-ray.

The draft manual, posted at www.DSM5.org, is up for public debate through April
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