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US mental health 'bible' DSM-5 updated | |
(1 day later) | |
An update to one of the most important manuals in mental health - known as the bible of psychiatry - has been unveiled. | |
Controversy and criticism has surrounded work on the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). | Controversy and criticism has surrounded work on the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). |
Critics say the rulebook turns normal behaviour, like grief or childhood temper tantrums, into mental illness. | |
It is used mainly in the US, but is influential around the world. | It is used mainly in the US, but is influential around the world. |
This is the first update to the volume since 1994. Experts in mental health have been taking account of the latest scientific developments to update ways of diagnosing mental disorders. | This is the first update to the volume since 1994. Experts in mental health have been taking account of the latest scientific developments to update ways of diagnosing mental disorders. |
The changes were presented at a meeting of the American Psychiatric Association (APA). | |
There are new categories including binge eating disorder, disruptive mood dysregulation disorder (previously known as childhood bipolar disorder) and hoarding disorder. | |
Meanwhile Asperger's syndrome is one of four previously separate conditions that have now become part of a single condition called autism spectrum disorder (ASD). | |
ASD now encompasses autism as known previously, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder which has not been specified. | |
The main symptoms of ASD are deficits in social communication and social interaction and restricted repetitive behaviours, interests, and activities. | |
The publication will have no effect on how people are diagnosed in the UK and other countries which use guidelines from the World Health Organization. | The publication will have no effect on how people are diagnosed in the UK and other countries which use guidelines from the World Health Organization. |
Attention deficit hyperactivity disorder (ADHD) has been modified to emphasise that this disorder can continue into adulthood. | |
Making normal ill | Making normal ill |
Ahead of the update, Prof Peter Kinderman, head of the Institute of Psychology at the University of Liverpool, argued on the BBC's Scrubbing Up column that: "[DSM-5] will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness." | |
He said "normal grief" would now be classed as a major depressive disorder and childhood temper tantrums would be a symptom of disruptive mood dysregulation disorder. | He said "normal grief" would now be classed as a major depressive disorder and childhood temper tantrums would be a symptom of disruptive mood dysregulation disorder. |
Also: "A wide range of unfortunate human behaviours, the subject of many new year's resolutions, will become mental illnesses - excessive eating will become 'binge eating disorder', and the category of 'behavioural addictions' will widen significantly to include such 'disorders' as 'internet addiction' and 'sex addiction'." | Also: "A wide range of unfortunate human behaviours, the subject of many new year's resolutions, will become mental illnesses - excessive eating will become 'binge eating disorder', and the category of 'behavioural addictions' will widen significantly to include such 'disorders' as 'internet addiction' and 'sex addiction'." |
Genes | Genes |
There is also criticism of the way DSM-5 classifies diseases based on symptoms. There are efforts to harness advances in genetics and neuroscience to diagnose people based on the cause rather than the symptoms of the illness. | |
The director of the US government's National Institute of Mental Health said the DSM had a "lack of validity". | |
Dr Thomas Insel posted a blog saying: "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. | Dr Thomas Insel posted a blog saying: "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." | "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." |
In some areas the distinction between disorders is narrowing. Autism, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia are all classed as separate disorders based on their symptoms. | In some areas the distinction between disorders is narrowing. Autism, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia are all classed as separate disorders based on their symptoms. |
However, research published in the Lancet medical journal in February showed all five disorders shared several genetic risk factors. | However, research published in the Lancet medical journal in February showed all five disorders shared several genetic risk factors. |
Dr David Kupfer, the chair of the DSM-5 task force, said: "The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care. | Dr David Kupfer, the chair of the DSM-5 task force, said: "The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care. |
"We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research." | "We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research." |
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