Updates to Bible of Psychiatry: Asperger's Out; Gambling Addiction In

By Andrew Moseman | February 10, 2010 10:58 am

brain puzzle mazePlenty has changed since the last update of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the operating manual for psychiatrists, was published in 1994. With the new fifth version set for a 2013 release, the task force behind the update released its recommended changes for public comment this week, and comments will likely come in droves.

The proposed changes touch many of the psychiatric issues that get people the most riled up. For example, the four separate diagnoses related to autism — autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified — would now be referred to as autism spectrum disorders [Los Angeles Times].

That won’t sit well with many people who have Asperger’s, Geraldine Dawson of the advocacy group Autism Speaks tells the Los Angeles Times, because they see their condition as something distinct from the others. People with Asperger’s usually don’t have the cognitive and verbal problems that often come with autism, and they can have savant-like abilities. Some scientists are displeased as well. “By massively pathologizing people under these categories, you tend to put them on an automatic path to medication, even if they are experiencing normal distress,” said Jerome C. Wakefield, a professor of social work and psychiatry at New York University [Washington Post].

Other proposed changes include officially classifying binge eating as disorder—but not obesity. Similarly, there’s a proposal to include “hypersexual disorder,” but neither sex nor Internet use (not you, dear reader) would fall under the new “behavioral addiction” category (though gambling would).

In another significant revision, the new DSM would add a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it. The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes [The New York Times].

Beyond shuffling the definitions of particular conditions, the new version of DSM would slightly alter the diagnostic process from the top, changing the definition of what a personality disorder is. The proposed revision suggests that instead of a pervasive pattern of thinking/emotionality/behaving, a personality disorder reflects “adaptive failure” involving: “Impaired sense of self-identity” or “Failure to develop effective interpersonal functioning” [Psychology Today].

But while that could sound to some ears like quibbling over semantics, the American Psychiatric Association says that the details that go into its bible couldn’t be more important. “It not only determines how mental disorders are diagnosed, it can impact how people see themselves and how we see each other,” said Alan Schatzberg, the association’s president. “It influences how research is conducted as well as what is researched” [Washington Post].

The ASA’s proposals are now up for review and public comment at dsm5.org.

Related Content:
80beats: Lancet Retracts 1998 Paper That Linked Vaccinations to Autism
Discoblog: If You’re Reading This Blog Post, You Might Be Mentally Ill
NCBI ROFL: Napoleon Dynamite: Asperger’s Disorder, Or Just a Geek?
Science Not Fiction: Is “Big Bang Theory” Bad For Science?

Image: iStockphoto

CATEGORIZED UNDER: Health & Medicine, Mind & Brain
  • Katharine

    I’m wondering if psychiatry and psychology are trudging down a bit of a dark path with this newest revision of the DSM.

  • http://www.ncpgambling.org keith

    pathological gambling is in DSM IV (and previous editions), what I think you mean is that it may be moved to a new category in DSM V.

  • forbvea

    Here’s something to stimulate your mind: A new psychological phenomenon has emerged. Cases are seen in something called psychogenic autism (factitious disorders) where the persons either deliberately feign being autistic or they really believe they are autistic. Normally, you find this in people who have taken large amounts of LSD type drugs, combined with a severly abusive past, thus resulting in a very mixed presentation of whatever it is they feel will bring them the most attention and nurturing. Autism is popular today, so many mentally ill persons are adopting this persona. Mainly, because few, if any professionals or media will challenge such a diagnosis after even a less than competant professional duped by the complexity of the presentation—validates it. Ooops, than it becomes a save face issue, where neither the media or the professionals (not to forget publishers who publish stories that later turn out not to be autistic people) involved in the faulty diagnosis want to be embarrassed. This is unfortunate, as this does a great disservice to the autism community in general. Recall the Amanda Baggs controversy and the case of Ms. Donna Williams. You Tube has a recent video out discussing some of this I’ve mentioned. It is on you tube under the name, “autism spectrum seems out of control” and another video named, “autism epidemic out of control.” The video has most definately hit on something few outside psychoanalytical or psychiatric circles, have even noticed

  • http://www.stevelifecoach.com dyingofpoetry

    Thank you forbvea, for capitalizing on what the autisitc community needs the least: an overall suspicion of who exactly is or is not autistic. Not like we already suffer enough dicrimination, autism being, after all, primarily a social deficit, but now any idiot with no psychiatric degree, or any degree for that matter, can have a field day saying, “Aha! See? There are people who are faking it. I’ll bet that’s you, you, you, and you!”

    Although what you have written maybe perfectly true, one must keep in mind that it is just as true of many psychiatric conditions and some physical diseases. Furthermore, it is nothing new. Malingerers will always chose whatever illness or condition is most convenient for them and will get them the most sympathy, so can we quit picking on autistic people? We’ve been picked on enough. Thanks.

  • fdpugh

    Whether you are “on spectrum” or not, having symptoms that are similar too those of autism puts you in a place socially which you cannot easily work your own way out of. Condensing Asperger’s Syndrome into the Autism spectrum with other similar deficit disorders will certainly change how it’s treated but will probably not be a big plus or minus in quality of treatment either way.

    Asperger’s is a primarily social deficit, but can be packaged with OCD, generalized anxiety disorders, and potentially many of the savant like characteristics of the “true” autistic syndrome. While the mechanism may be the same; those with Asperger’s, once their other issues are managed, can be trained to interact with relative normality… we’re just a little odd.

    Psychology/psychiatry is really a hobby science anyway – since they don’t have the same ability to perform experiments with concrete, affirmative, and nullifiable results the best they have are conjectures which may be a “best fit” model.

    Considering they prescribe psychoactive medications without actually knowing what specific neuro-chemistry they are affecting in a given patient it is really more of an art than anything.

    Let them categorize these things as they wish; a truly competent and skilled practitioner isn’t likely to be going strictly by the book in any case.

  • http://www.tahminder.com iddaa

    Psychology/psychiatry is really a hobby science anyway – since they don’t have the same ability to perform experiments with concrete, affirmative, and nullifiable results the best they have are conjectures which may be a “best fit” model.

    this part is good idea

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