May 18, 2013

Do psychiatric guide's new labels put ‘normal’ at risk?

DSM-5, the updated source for diagnosing mental problems, has many questioning its legitimacy.

By LINDSEY TANNER The Associated Press

CHICAGO - In the new psychiatric manual of mental disorders, grief soon after a loved one's death can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain "senior moments" are called "mild neurocognitive disorder."

male eating disorder
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A psychiatric patient stands next to a painting he did at a hospital in Elgin, Ill. Even the head of the U.S. National Institute of Mental Health has complained that the proposed new manual for diagnosing mental disorders lacks scientific validity.

Stacey Wescott/Chicago Tribune/MCT

Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common human problems into mental illnesses in a trend they say will just make the "pop-a-pill" culture worse.

Says a former leader of the group: "Normal needs to be saved from powerful forces trying to convince us that we are all sick."

At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It's the manual's first major update in nearly 20 years, and a backlash has taken shape in recent weeks:

Two new books by mental health experts, "Saving Normal" and "The Book of Woe," say the world's most widely used psychiatric guide has lost credibility.

A British psychologists' group is criticizing the DSM-5, calling for a "paradigm shift" away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide.

Even the head of the U.S. National Institute of Mental Health complained that the book lacks scientific validity.

This week, the NIMH director, Dr. Thomas Insel, tried to patch things up as he and the psychiatrists group issued a joint statement saying they have similar goals for improving the diagnosis and treatment of mental illness.

The manual's release comes at a time of increased scrutiny of health care costs and concern about drug company influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

"Way too much treatment is given to the normal 'worried well' who are harmed by it; far too little help is available for those who are really ill and desperately need it," Dr. Allen Frances writes in "Saving Normal." He is a retired Duke University professor who headed the psychiatry group's task force that worked on the previous handbook.

He says the new version adds new diagnoses "that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders."

Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual -- including autism, attention deficit disorder and bipolar disorder -- and billions of dollars spent each year on psychiatric drugs.

The group's 34,000 members are psychiatrists -- medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.

The most contentious changes include:

Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one's death. Major depression is typically treated with antidepressants.

Calling frequent, extreme temper tantrums "disruptive mood dysregulation disorder," a new diagnosis. The psychiatric association says the label is meant to apply to youngsters who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness.

Diagnosing mental decline that goes a bit beyond normal aging as "mild neurocognitive disorder." Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize "senior moments."

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