This manual is the “bible” by which psychiatry professionals diagnose and treat mental illnesses.
Produced by the American Psychiatric Association (APA), the DSM’s fifth edition marks the first major revision in two decades and has sparked a lot of controversy and discussion – so much so that even the nation’s largest mental illness research arm, NIMH, has dropped the book from its research criteria.
The controversy in the media has surrounded some of the more sensational additions to the book. But internally, medical professionals are more concerned about changes and additions that may seem more mundane to the layperson. Those include changes to Asperger’s syndrome, which is no longer a part of the autism spectrum in the DSM-5, and additions to the clinical depression entries.
Asperger’s No Longer Autism
The book’s revisers at the APA say that the removal of Asperger’s from the autism spectrum is because many sufferers do not otherwise show signs of autism and the syndrome therefore deserves its own entry instead.
This seems minor, but to autism sufferers and experts, it’s drastic. It could mean that some Asperger’s patients in the U.S. or Canada may lose treatment options as insurance and government coverages change with the new manual. Many services offered by various public and private programs are offered to autism patients, not “Asperger’s patients,” and if the syndrome is no longer considered autism, those services could be suspended or lost.
Depression Now Broader
Another change that has sparked internal controversy within the ranks of psychiatry is the broadening of the definition of clinical depression. Previously, patients had to show signs of unhappiness or lack of pleasure for weeks or even months at a time. Now, with DSM-5, the time period is only two weeks.
Many opponents to this change say that it is creating a medical condition out of a normal human emotional response. The loss of a close loved one, pet, or other bereavement may last for days or even weeks, which would now make it “clinical depression” from which a medicated patient could find no recovery, whereas without medication the person may have recovered naturally.
The General Hit-or-Miss Problem with the DSM
Many critics of the psychiatry manual get directly to the point: The DSM focuses on symptoms in an approach that often misses or misdiagnoses. This leads to treatments that don’t work and themselves become hit-or-miss as well, putting patients on a roller coaster.
With the broadening of depression and changes in other criteria within the DSM-5, some argue that the misses may become even more common. Some are wondering if this could be part of the huge rise in mental health diagnosis.
One thing is clear: The DSM-5 is not a well-received change to the psychiatric manual, and it may be years before the controversy is allayed.