Published Online: December 11, 2012
Published in Print: December 12, 2012, as Psychiatrists Revising Manual on Mental Disorders

Psychiatrists Revise Guide for Diagnosing Mental Disorders

The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by U.S. psychiatrists. Changes were approvedRequires Adobe Acrobat Reader earlier this month.

Full details of all the revisions will come next May when the Arlington, Va.-based American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools determine which students should be enrolled in special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. He said it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Dr. Olfson was not involved in the revision process. The changes were approved by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

Asperger's or Autism?

One of the most hotly argued changes was how to define the range of those with autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's syndrome. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

Some Asperger's families opposed any change, fearing their children would lose their diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, some experts say, especially if students were reclassified as having "autism spectrum disorder."

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The new manual adds the term autism spectrum disorder, which many experts already use. Asperger's disorder and PDD-NOS, or pervasive developmental disorder-not otherwise specified, will be dropped and incorporated under that umbrella diagnosis. The new category will include children with severe autism, who often don't talk or interact, as well as those with milder forms.

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said she welcomes the change. Her boys all had different labels in the old diagnostic manual, including Asperger's.

"To give it separate names never made sense to me," Ms. Gibson said. "To me, my children all had autism."

Autism researcher Geraldine Dawson, the chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

People with dyslexia did not want their diagnosis to be dropped and it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The shorthand name for the new edition, the fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Leaders said specifics won't be disclosed until the manual is published but they confirmed some changes.

One is a new diagnosis for severe recurrent temper tantrums—disruptive mood dysregulation disorder. Critics say it will "medicalize" children who have normal tantrums. Supporters say it will address concerns about too many children being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs.

Vol. 32, Issue 14, Page 15

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