The Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, governs the tricky science of psychiatric diagnosis. But this gold standard of diagnosis is anything but infallible: as knowledge of mental disorders grows, successive editions have had to change their definitions. The fifth version, due to be published next year, is already drawing criticism—and the most recent attack comes from within the DSM-5’s ranks.
Roel Verheul and John Livesley, a psychologist and psychiatrist who were members of the DSM-5 work group for for personality disorders, found that the group ignored their warnings about its methods and recommendations. In protest, they resigned, explaining why in an email to Psychology Today. Their disapproval stems from two primary problems with the proposed classification system: its confusing complexity, and its refusal to incorporate scientific evidence.
Yesterday the American Academy of Pediatrics issued new guidelines for treating attention deficit hyperactivity disorder, or ADHD, expanding the age range at which the condition can be diagnosed to include kids as young as 4 years old all the way up to young adults aged 18. The previous guidelines, made a decade ago, limited diagnoses to kids ages 6 to 12. The physician group decided to make the change due to new evidence that ADHD symptoms can surface in preschool-aged children and persist later into adolescence and adulthood than previously recognized. The report says methylphenidate (Ritalin) may help control ADHD symptoms in children ages 4 and 5, though only one large study has been done to support this conclusion. The authors stress, however, that medication should only be given after behavioral modifications are attempted—and that Ritalin may have some serious possible side effects like irreversibly slowing growth.
Plenty 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].