CHICAGO – For the first time in almost two decades, the nation’s psychiatrists are changing the guidebook they use to diagnose mental disorders. Among the most controversial proposed changes: Dropping certain familiar terms like Asperger’s disorder and dyslexia and calling frequent, severe temper tantrums a mental illness.
The board of trustees for the American Psychiatric Association voted Saturday in suburban Washington, D.C., on scores of revisions that have been in the works for several years. Details will come next May when the group’s fifth diagnostic manual is published.
The trustees made the decision on what proposals made the cut; recommendations came from experts in several task force groups assigned to evaluate different mental illnesses.
The update’s impact will be huge, affecting millions of children and adults worldwide.
The manual “defines what constellations of symptoms health care professionals recognize as mental disorders and more importantly … shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care,” said Dr. Mark Olfson, a Columbia University psychiatry professor who was not involved in the revision process.
The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.
The guidebook’s official title is the Diagnostic and Statistical Manual of Mental Disorders. The new one is the fifth edition, known as the DSM-5. A 2000 edition made minor changes but the last major edition was published in 1994.
The manual “seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 … there have been important advances in our understanding of the nature of psychiatric disorders,” Olfson said.
Expected changes include formally adopting a term for children and adults with autism — “autism spectrum disorder,” encompassing those with severe autism, who often don’t talk or interact, and those with mild forms including Asperger’s. Asperger’s patients often have high intelligence and vast knowledge on quirky subjects but lack social skills.
Some Asperger’s families opposed the change, fearing their kids would lose a diagnosis and no longer be eligible for special services. And some older Asperger’s patients who embrace their quirkiness vowed to continue to use the label.