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DSM-5
February 9, 2010 9:12 PM   Subscribe

At midnight tonight, the American Psychiatric Association (APA) released a proposed draft of the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Some notable changes:

-Addition of dimensional assessments
-Addition of standardized way to assess disorder severity
- Binge Eating Disorder added to eating disorders
- Asperger Syndrome removed and folded into the autism spectrum disorder umbrella
-Addition of Nonsuicidal Self-Injury


It appears that no changes were made to Gender Identity Disorders, which had been a focus of concern.

The APA is seeking public comment from health professionals, consumers of mental health services, and family members of people with mental disorders until April 20, 2010.

The DSM-5 will be published in May 2013.

Previously
posted by emilyd22222 (58 comments total) 9 users marked this as a favorite

 
this article on the history of the DSM (linked in the 'previously' link) is really fascinating. It's kind of surprising just how unscientific the whole endeavor actually was.
posted by delmoi at 9:21 PM on February 9, 2010 [1 favorite]


The new phone book's here! The new phone book's here!
posted by doctor_negative at 9:21 PM on February 9, 2010 [20 favorites]


Never read the DSM if you're not a trained specialist. You'll convince yourself you have at least forty or fifty pages worth of afflictions, and you'll thumb through it checking off various unpleasant disorders you're positive your boss has. I hate to break it to you, but forgetting to make a new pot of coffee after pouring the last cup is not indicative of selective amnesia due to post traumatic stress, and therefore grounds for immediate institutionalization, however much we'd like it to be.
posted by Slap*Happy at 9:26 PM on February 9, 2010 [19 favorites]


"Asperger Syndrome removed and folded into the autism spectrum disorder umbrella"

Jeez, APA, you just put the kibosh on a third of all internet discussions.
posted by Kattullus at 9:31 PM on February 9, 2010 [13 favorites]


On the other hand, everybody may have to go back & re-do their online Aspergers self-diagnoses.
posted by UbuRoivas at 9:35 PM on February 9, 2010 [6 favorites]


I was going to say something rude wondering if AskMe was going to have an increase in people self-diagnosing themselves with disorders based on this post, but hopefully Slap*Happy's warning has happened early enough in the thread to prevent that.

But seriously, the DSM is called a bible and I think I know why. Because it's a book that can be really helpful, but iin the wrong person's hands, selective reading and misunderstanding can lead to a whole lot of damage.
posted by MCMikeNamara at 9:36 PM on February 9, 2010 [8 favorites]


Could a trained specialist explain which DSM category is appropriate for

(a) people who continue to question whether Duchamp's Fountain is art?

(b) load the toilet paper so that it descends from the back/bottom of the roll rather than the top/front?

(c) frequently reply in the form of enumerated or bullet point lists?
posted by b1tr0t at 9:40 PM on February 9, 2010 [3 favorites]


You'll convince yourself you have at least forty or fifty pages worth of afflictions

Heck, watching a medical show can have the same effect. Ask anyone who works in an ER about how many people show up after each episode of House convinced that they have a rare parasite from Malaysia, or whatever the diagnosis du jour was.
posted by Jimmy Havok at 9:41 PM on February 9, 2010


(d) are excessively happy when one of the earliest comments justifies tl;dr
posted by b1tr0t at 9:41 PM on February 9, 2010


...after each episode of House convinced that they have ... whatever the diagnosis du jour was.

What about the poor doctor having to explain that no, lady, it actually is Lupus.
posted by griphus at 9:46 PM on February 9, 2010 [9 favorites]


Hmm... I see that they're proposing to rename the disorder I've been diagnosed with. The old name, dysthymia, while prettier, was rather untransparent. Chronic depressive disorder is more readily understandable. I had a little patter down for the occasions I've told people about it, which included a bit of explication of the name (Greek for ill humor). The sentence "I've been diagnosed with chronic depressive disorder" requires very little explanation. I kinda liked my little patter.

In case you're wondering, I'm pretty good at keeping my mood under control.
posted by Kattullus at 9:49 PM on February 9, 2010 [2 favorites]


Shouldn't this thread have the batshitinsane tag?
posted by Goofyy at 9:50 PM on February 9, 2010 [6 favorites]


Have they finally recognized Never Nudes?
posted by zinc saucier at 10:09 PM on February 9, 2010 [25 favorites]


Oh goody! (I'm a big dork for the DSM and I think I'll be staying up late to read through this.)
posted by sperose at 10:14 PM on February 9, 2010


Do they have to try and run an Active X control upon me visiting their page? What content is so fucking important that I need that.
posted by Ironmouth at 10:19 PM on February 9, 2010


forgetting to make a new pot of coffee after pouring the last cup is not indicative of selective amnesia due to post traumatic stress, and therefore grounds for immediate institutionalization, however much we'd like it to be.

Pfft, of course not! It's evidence of Antisocial Personality Disorder (301.7).
posted by ErikaB at 10:49 PM on February 9, 2010 [1 favorite]


tl;dr

tr;dsm-iv
posted by davejay at 11:13 PM on February 9, 2010


I see they've taken the bold step of renaming the ADHD section to "314.9 Attention Deficit/Hyperactivity Disorder Not Otherwise Hey Let's Go Ride Out Bikes!"

oh im gonna catch hell for that one
posted by davejay at 11:16 PM on February 9, 2010 [8 favorites]


and I misspelled it too. don't worry, I'm taking myself out to the woodshed.
posted by davejay at 11:17 PM on February 9, 2010


I'm wondering if they removed or clarified schizoaffective disorders, but I'm not going to read it tonight.
posted by BrotherCaine at 11:20 PM on February 9, 2010 [1 favorite]


Argh, they have one called "312.34 Intermittent Explosive Disorder." It's like they want everyone to hate me. I'm gonna stop reading now.

must not tell joke must not tell joke
posted by davejay at 11:22 PM on February 9, 2010


(c) frequently reply in the form of enumerated or bullet point lists?posted by Pinback at 11:42 PM on February 9, 2010 [6 favorites]


Do we all still want to screw Mom in the latest edition? Are the gays crazy in this one? Is abetting torture enhanced interrogation still ethical? Any, um, falsifiable hypotheses developed via systematic empiricism?
posted by orthogonality at 11:59 PM on February 9, 2010 [3 favorites]


Ooh, I wonder what kind of crazy I'll be today!
posted by idiotfactory at 12:14 AM on February 10, 2010


Never read the DSM if you're not a trained specialist.

I'll go one further: never quote the DSM to diagnose people you're ostensibly trying to help or to pathologize the behavior of people you happen to dislike. It's a cornucopia of poor thinking: playing doctor, making unsupported leaps of logic, and most of all using a healing tool as a cudgel. There's a lot of mistrust for therapists out there, some of it reasonable, but at least they can be held to a code of ethics, including very specific standards for assessment. No trained professional with a conscience would ever abuse the DSM this way and it always sticks in my craw to see an overconfident layperson do so.
posted by melissa may at 12:30 AM on February 10, 2010 [1 favorite]


Ask MetaFilter: playing doctor, making unsupported leaps of logic, and most of all using a healing tool as a cudgel.
posted by UbuRoivas at 12:42 AM on February 10, 2010 [2 favorites]


But seriously, the DSM is called a bible and I think I know why. Because it's a book that can be really helpful, but in the wrong person's hands, selective reading and misunderstanding can lead to a whole lot of damage.
posted by MCMikeNamara at 9:36 PM on February 9


Also because many take this book to be absolute truth and what is written determines the movement of billions of dollars.

On first look, this edition is a vast improvement.
They did well to merge all the schizophrenic classifications. However, I am disappointed that more merging wasn't done. I think think the similarities between impulse control, obsessive/compulsive, and certain sexual disorders would qualify for shared classification.
posted by psycho-alchemy at 1:02 AM on February 10, 2010


When I got psychiatry lectures in school DSM-III was just out; now I feel old.
posted by TedW at 2:54 AM on February 10, 2010


Fascinating to see the move taken on Asperger's, as health care professional that I know and work with here already place it in the high functioning end of the autistic spectrum.
posted by Marisa Stole the Precious Thing at 3:02 AM on February 10, 2010


Where is the link to the web form so I can vote for my favorite new disorder? I'm going with Internet addiction in conjunction with depression, chicken or egg?
posted by fixedgear at 3:15 AM on February 10, 2010


Wow! The NPR story on the Aspergers disinclusion is SO telling. A guy in charge of an Aspergers group basically says, "But we're special snowflakes like Einstein and Emily Dickinson! And now you're telling us that we're just freaks. Sadface."

Aspergers is the ugly love child of the Tortured Genius Myth and the Secondary Gains of Illness. Ugh.
posted by greekphilosophy at 5:24 AM on February 10, 2010 [5 favorites]


Never read the DSM if you're not a trained specialist. You'll convince yourself you have at least forty or fifty pages worth of afflictions, and you'll thumb through it checking off various unpleasant disorders you're positive your boss has. I hate to break it to you, but forgetting to make a new pot of coffee after pouring the last cup is not indicative of selective amnesia due to post traumatic stress, and therefore grounds for immediate institutionalization, however much we'd like it to be.

You're ruining Wednesdays. I leave helpful notes to remind you how crazy you are!
posted by a robot made out of meat at 5:32 AM on February 10, 2010 [1 favorite]



Never read the DSM if you're not a trained specialist.


Try telling that to thousands of undergrad psych majors everywhere. Sure didn't stop me. Good times, baby!
posted by Halloween Jack at 5:42 AM on February 10, 2010


I think it's pretty cool that they've released a draft and are asking for public comment. I like the idea of open process, generally, and I'm glad to see that they aren't hiding the DSM behind a wall of experts.

It appears that no changes were made to Gender Identity Disorders, which had been a focus of concern.

This isn't entirely true. If you check out the link, you can read the rationale behind the various changes. Notably, it seems that they have removed the requirement of "distress/impairment" in gender identity disorders, in recognition that (a) such a diagnosis doesn't necessarily indicate impaired functioning or distress, and (b) that distress associated from this disorder is largely due to the social stigma attached to transgenders, rather than inherent in the disease itself. This is certainly a step forward, since it seems to indicate a normative shift in our understanding of transgenders persons.

After reading this, I also went on to read about other sexual disorders. It seems that they've done a reclassification of the paraphilias. Each paraphilia has two categories, (a) and (b), with the associated disorder diagnosed only if you meet the requirements of the second category. They've removed "distress/impairment" type indicators from the first category. As the rationale states: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological."

I think this is another step forward. I know there are many MeFites who enjoy alternative sexual practices, and they'll be happy to know that things like fetishes, S&M, etc., are no longer automatic qualifiers for a psychiatric disorder. I'm sure this is painfully obvious to many MeFites (including myself...and excuse the pun), and is something that should have been recognized years ago. Still, its nice to see it reflected in mainstream psychiatric diagnoses.
posted by HabeasCorpus at 6:00 AM on February 10, 2010 [4 favorites]


(b) load the toilet paper so that it descends from the back/bottom of the roll rather than the top/front?

Someone explained to me that, in a house with small children, the nonstandard roll positioning prevents rapid unspooling by tiny hands.
posted by electroboy at 6:15 AM on February 10, 2010 [1 favorite]


YAY!
posted by kathrineg at 6:55 AM on February 10, 2010


Re: GID...

Actually, there are several changes and on my first read they appear to be positive ones:

* The default wait period for diagnosis-indicative questions has dropped from a year to six months. This is -huge-, especially for children.

* The "distress/impairment" requirement is proposed to be dropped. Also huge. Basically, this means that you can be diagnosed without saying "I am going to die unless something changes."

* It is proposed that the name gender identity disorder (GID) be replaced by "Gender Incongruence" (GI), because "...in a recent survey ... many very clearly indicated their rejection of the GID term because, in their view, it contributes to the stigmatization of their condition."

I would have loved for there to be an explicit statement that this is a biologically-based diagnosis, such that insurance companies have even fewer excuses not to provide coverage. But overall, a quite surprising positive change.
posted by andreaazure at 7:01 AM on February 10, 2010 [2 favorites]


I think the similarities between impulse control, obsessive/compulsive, and certain sexual disorders would qualify for shared classification.

Agreed, psycho-alchemy, although I'm interested in the association with eating disorders as well. I haven't had time for more than a cursory glance (and the site's search isn't working for me) , but it looks like the OCPD diagnostic criteria will remain the same. Rats - I'd been hoping for a change in the criteria, if not a reclassification.

I'm glad to see the reorganization of the addiction & related disorders group, especially moving pathological gambling from Impulse Control and adding the substance-induced tic and anxiety diagnoses under Anxiety.
posted by catlet at 7:14 AM on February 10, 2010



I think the similarities between impulse control, obsessive/compulsive, and certain sexual disorders would qualify for shared classification.


I kind of disagree, actually, considering that obsessive/compulsive disorder definitely belongs on the anxiety spectrum, whereas it seems they have removed a lot of these requirements for sexual disorders and impulse control (no need for a showing of "distress").
posted by HabeasCorpus at 7:25 AM on February 10, 2010


Jeez, APA, you just put the kibosh on a third of all internet discussions.

On the other hand, everybody may have to go back & re-do their online Aspergers self-diagnoses.

They're not denying the existence of the syndrome, they're folding it back into Autism Spectrum Disorders along with PDD-NOS. The current distinction between the three leads to kids being diagnosed with PDD-NOS by one clinician, Autism by the other, Asperger's by a third-- meaning the distinction between the three is so subjective as to be useless.

There are certainly people who are autistic, high-functioning, of average or above-average intelligence, with relatively good expressive language capabilities. Those people won't be officially diagnosed with Asperger's; instead they will be diagnosed as having autism.


greekphilosophy: "Aspergers is the ugly love child of the Tortured Genius Myth and the Secondary Gains of Illness. Ugh."

Ugh, people making the best of their disability. Ugh, people with an inability to socialize normally saying socially inappropriate things.
posted by kathrineg at 7:26 AM on February 10, 2010 [4 favorites]


If I start reading it I won't get any work done. Do they have sex addiction it it?
posted by bukvich at 8:00 AM on February 10, 2010


Having worked in a firm that EXCLUSIVELY represented disabled folks for three years while in law school, I'm even willing to go out on a limb and consider that guy an advocate who is trying to remove the stigma of a misunderstood and oft maligned mental disorder.

Plenty of people do that without having to PUT DOWN people with other disorders. This guy was CLEARLY over that line. I should have included the quote. He said that he was disappointed to be lumped in with people who have to wear adult diapers and head restraints when he knows that his disorder is one attributable to geniuses.

So yeah. Socially maladapted person is socially maladapted. But I would suggest he get a PR person who IS able to properly socialize.

As for making the best of their disability - he wasn't doing anything of the sort. Making the best of your disability does NOT include shitting on someone else.
posted by greekphilosophy at 8:01 AM on February 10, 2010 [2 favorites]


in it.
posted by bukvich at 8:01 AM on February 10, 2010


I've known a couple of people diagnosed with Asperger's, one socially and one was the adopted son of an acquaintance. It's a lot more than "people with an inability to socialize normally saying socially inappropriate things." These two had it considerably bad. They were both unable to understand social cues of any kind. I learned pretty quickly that I needed to spell things out, and not hint or assume common understanding, but that's not something that's intuitively obvious. Both were often distressed at finding themselves berated (or worse) for unknown reasons and just generally feeling excluded from normal society. And having to think through every little social interaction is exhausting. These two had a really rough time of it, so on top of everything they developed depression and stress-related health problems. I'm no expert on autism, but from having known these two guys I'd say it's a rather awful condition.
posted by Kattullus at 8:08 AM on February 10, 2010


That asshole Aspergers is the ugly love child of the Tortured Genius Myth and the Secondary Gains of Illness. Ugh.

FTFMyself

Sorry people with Aspergers. I don't have anything against you or your disorder. Nor do I think your disorder is fake, or an excuse, or non-debilitating.
posted by greekphilosophy at 8:18 AM on February 10, 2010


My point is that people with Asperger's are often mocked (here and other places). I hate seeing it. "Hey, look at that socially maladjusted asshole! LOL! People who say they have Asperger's are so weird!" Well, no shit. That's a significant part of the disorder. On preview, thanks for your followup.

From my window into the autistic brain, it's probably the huge variability of the spectrum and the sheer fact that the name will be different (CHANGE!) that annoys that NPR guy.

I mean look orange juice and apple juice are both completely fucking different, kathrine, and yet you call them both JUICE without SPECIFYING *cue complete meltdown freakout*

That's what this sounds like to me, moreso than pride or snobbery.
posted by kathrineg at 8:33 AM on February 10, 2010


NPR's Morning Edition had a couple of good pieces on two of the changes this morning, well worth listening to.

Asperger's Officially Placed Inside Autism Spectrum

New Diagnosis Proposed For Kids Labeled 'Bipolar' (includes good explanation of why what has been commonly diagnosed as "bipolar disorder" in children doesn't really fit with adult bipolar disorder)
posted by DevilsAdvocate at 9:25 AM on February 10, 2010


Here's the a text version of the NPR bipolar story for those who prefer reading to listening.

More from NPR: Cutting and binge eating now included as disorders. (And for the tl;dr;quick-to-snark foks, "We're not talking intermittent overeating — that is normal — but this is recurrent, persistent, frequently occurring, accompanied by lots of distress, guilt and unhappiness.")
posted by DevilsAdvocate at 9:34 AM on February 10, 2010


And it was released at midnight . . . why? That seems very odd, especially for a reference book for mental health disorders.
posted by bearwife at 10:01 AM on February 10, 2010


The point is that people with actual Asperger's are quite rare. The other ones, people that self-diagnose after reading a list of symptoms online, however, deserve all the ridicule they get.
posted by ymgve at 10:03 AM on February 10, 2010


I don't think so ymgve. Nobody who is having a hard time deserves ridicule.

I think they need proper treatment for whatever it is that ails them - even if it a case of hypochondria or generalized anxiety or low self-esteem or the sniffles. For all our work at classifying mental disorders, we're still stunningly bad at identifying them and treating them and helping people with them live as happily as possible. We're also terrible about creating a hospitable environment in which people *want* to seek proper treatment. And comments like the one you just made (and the one I made earlier) contribute to that hostile environment.

I'm ashamed of the comment I made. And you should be ashamed of your comment.
posted by greekphilosophy at 10:52 AM on February 10, 2010 [1 favorite]


are hipsters in there yet ?
posted by sgt.serenity at 11:11 AM on February 10, 2010


I think the similarities between impulse control, obsessive/compulsive, and certain sexual disorders would qualify for shared classification.

I kind of disagree, actually, considering that obsessive/compulsive disorder definitely belongs on the anxiety spectrum, whereas it seems they have removed a lot of these requirements for sexual disorders and impulse control (no need for a showing of "distress").
posted by HabeasCorpus


I guess I can somewhat agree because anxiety is definately a motivating factor. The main differences that I notice is that the other impulse disorders (in most cases) are motivated by possible positive reinforcement. Whereas OCD is motivated by a negative reinforcement. But structurally they seem very similiar to me.

I guess the DSM 5 is still more concerned with the presenting signs and symptoms than the underlying cause or treatment. Mores the pity.

Further

Oh noes! They taking my axis 1 and 2!
No mention of a change in the cross-cultural treatment or culture bound disorders.
posted by psycho-alchemy at 2:08 PM on February 10, 2010


greekphilosophy, you're right in that no one who is having a hard time should be mocked or punished due to self-diagnosing (or being diagnosed as being) a case of Asperger's.

I don't think anyone should feel ashamed for being cynical about the number of people who self-diagnose as a way of claiming that they have some natural predisposition to be good at certain organized or logical endeavors while having an excuse for being an asshole to people. Some individuals do that. They cheapen the real diagnosis.
posted by mikeh at 8:23 AM on February 11, 2010


That's such a limited view of human suffering though - people who are grasping at a diagnosis are not doing so to "cheapen" that diagnosis. They are doing so because nobody is paying attention to their very real need. Cynicism is just another way to ignore these people and their suffering.
posted by greekphilosophy at 8:46 AM on February 11, 2010 [1 favorite]


The head of the task force that prepared the DSM IV lists the 19 worst aspects of the draft proposal.
posted by Obscure Reference at 4:50 PM on February 15, 2010


Wow, that guy was very lazy in his criticisms.

He disagrees with the ADHD age-of-onset change, and his reference is to an article that provides incredibly compelling evidence for that change. He also links to two studies that show that people misuse prescription stimulants. Apparently that is a good reason to completely ignore the evidence that 7 as the age of onset is not supportable.

He thinks that ADHD and autism can't coexist, doesn't reference why but says it will increase stimulant use in an already vulnerable population. Yes, a vulnerable population that includes people with ADHD. ADHD that responds to treatment just like it does in non-autistic children. There is no reason for the autism exclusion in the ADHD diagnostic criteria.

He thinks that autism is overdiagnosed because of the creation of critera for Asperger's syndrome and he thinks that folding it into ASD will make this overdiagnosis worse; his reference is a paper that states that autism rates are rising. It proves in no way that autism is overdiagnosed or that it is overdiagnosed because of Asperger's. In fact, it has nothing to do with Asperger's because it measures the increase of ASD diagnoses. Asperger's isn't even mentioned in the paper he cites.

This is my favorite part:

"Another side effect would be deletion of five of the personality disorders (paranoid, narcissistic, histrionic, dependent, schizoid) from the manual."

What's wrong with that? Four out of five of those personality disorders don't seem to exist.
posted by kathrineg at 6:48 PM on February 15, 2010 [2 favorites]


He thinks that autism is overdiagnosed because of the creation of critera for Asperger's syndrome

To be fair, he says that this is part of the reason for the overdiagnosis; he doesn't say it's the only reason.
posted by kathrineg at 6:49 PM on February 15, 2010


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