In huge mental health news, the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released this week at the American Psychiatric Association’s Annual Meeting. Known as the authoritative guide for clinicians, the DSM-5 is the latest edition that helps to define, diagnose, and treat mental health disorders.
So what does a new edition mean for you? As with previous versions, this newest guide takes into account new research to add to, remove from, and tweak the list of disorders and their criteria. The goal? To make it as useful as possible. “Starting [May 21], one can look at these criteria sets and be able to utilize them for more precise diagnoses than we’ve been able to do in the past,” says David Kupfer, MD, Task Force Chair for the DSM-5.
The hope is that this new edition will be even better at diagnosing and treating patients. “Determining an accurate diagnosis is the first step toward being able to appropriately treat any medical condition, and mental disorders are no exception,” says Kupfer.
Not everyone is so thrilled about this latest edition, though. Critics of the DSM-5 worry that the new criteria for disorders may lead to overdiagnosis since more disorders have been added and the requirements for some have been modified.
Thomas Insel, MD, director of the National Institute of Mental Health, recently announced that the NIMH plans to turn their research away from the DSM. As Insel noted in a recent blog post on the topic, “We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data—not just the symptoms—cluster and how these clusters relate to treatment response.” Translation: the NIMH would rather diagnose people based on lab tests and science—rather than using a symptom-based approach like the DSM encourages.
It took researchers 19 years to finalize this revision, so it’s understandable if you’re a little confused about it. Here, a few major things you need to know about the DSM-5:
New disorders were added
A few disorders, like Premenstrual Dysphoric Disorder (PMDD, a severe form of PMS that may be related to low levels of serotonin), Binge Eating Disorder, and Caffeine Withdrawal, have been moved from the appendix to the main text. A disorder is listed in the appendix when it requires a little bit more research and is moved into the main text when the researchers feel that it meets a certain criteria. Because they’re now listed in the main text of the DSM-5, treatment and services related to these illnesses will now be covered by health insurance, says Kupfer. Other additions include the diagnoses for Hoarding Disorder and Excoriation (Skin-Picking) Disorder, neither of which were even mentioned in previous editions.
Not all the rumors are true
There was a ton of speculation about what changes the DSM-5 would include, but not everything was accurate. You may have heard, for example, that the section on personality disorders was getting reorganized and that a few diagnoses would be thrown out. In the end, because of the strong feedback they received, the task force decided to keep the same categories from the DSM-IV, and all 10 personality disorders are intact. They did, however, decide to include the proposed revisions into the back of the book to encourage further research on them and keep them in consideration for a future edition.
Another rumor was that sexual addiction or hypersexuality would be added as a disorder, but Kupfer says that the task force didn’t have sufficient research to put it in the main text or even the appendix.
Your insurance may take a while to catch up
When a disorder is defined in the DSM, it helps insurance companies to know what services should be covered. Unfortunately, these changes won’t happen overnight. While doctors can start using the DSM-5 immediately, insurance companies may take a while to update their claims forms and procedures, says Kupfer. “The American Psychiatric Association (APA) is working with these groups with the expectation that a transition to DSM-5 by the insurance industry can be made by December 31, 2013,” says Kupfer.
It will be online soon
You may have noticed that the DSM-5 uses the Arabic numeral for five instead of roman numerals, which is how it was written in the past (like DSM-IV, DSM-III, etc.). This is because the task force is hoping to update this version more frequently and simply than before. “We see a 5.1 and a 5.2,” says Kupfer. “Since this will be online, we will be able to make changes when it’s appropriate.” They expect it to be on the web in June 2013 and available on a subscription basis, with fees varying depending on your use.
Your doctor might not be totally behind it
While the creators of the DSM-5 hope it will be the new gold standard in diagnosing mental illness, it may not be widely accepted right away. Many clinicians have criticized the new text for either being too broad in scope or trying too hard to fit patients into distinct categories. In a recent blog post for Psychology Today, for example, Allen Frances, MD, (former chair of the DSM-IV Task Force) advises clinicians not to use the new edition and suggests patients become informed consumers when it comes to a diagnosis—just as they would when buying a car.
Kupfer says he thinks the DSM-5 will catch on in the medical community—eventually. “I think there’s going to be a transition,” he says. “I think some people will take a little longer than others.
If you are considering or currently seeking treatment for a disorder, Kupfer suggests having a conversation with your doctor about the new edition and asking about any effect it may have on your diagnosis or treatment.
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