The DSM-IV-TR, or the manual used by doctors, psychiatrists, and therapists among others, is currently under reconstruction. It's scheduled to be distributed in 2013. This means that the terms professionals learned in school and on the job may no longer apply in some cases. While this may seem like an insignificant event to many, for those suffering with a mental illness the implications may be far reaching.

The term Narcissist, for instance, has come to be a pretty common word in our vernacular. Most people know what someone means when they say he or she “is a Narcissist.” But the word actually has a very descriptive, and well thought out definition. Most people, who are referred to as a Narcissist, don’t actually qualify for a diagnosis, but for those who do, the diagnosis itself can be damming. The most useful element of the term is that it can be helpful as a way for experts to communicate about a patient’s treatment.

As is the case with so many diagnostic terms, it is a communication shortcut between professionals. I will admit that it is a useful term for that purpose. Historically if a clinician gave a diagnosis of Narcissistic Personality Disorder (or any other personality disorder,) insurance companies would deny payment. The reason for this was that the disorder itself was considered untreatable and therefore insurance companies made the claim that treatment was therefore unwarranted. Of course this is ridiculous and most people who qualify for a diagnosis of a personality disorder also have concurrent diagnoses, such as depression or anxiety that insurance companies deem worthy of treatment.

As this new version of an old manual, originally designed for the U.S. Armed Forces in 1952, takes shape the debates about what to include, exclude, or revise are plenty. Its importance over the years has grown and it is now considered the primary source for psychiatric diagnoses. Even a small change to the wording of the manual can have a profound effect. In some instances the altered definition of a diagnosis would now include those who would have been previously excluded and, in other cases, a person may no longer qualify for a diagnosis they had earlier been given. Not only will these changes have medical implications but also it could affect how certain behaviors are seen in the legal system and therefore qualify a person for an insanity plea. The economic effects, as it pertains to our already disastrous insurance system in the U.S., could be huge as well.

Clearly the manual needs some updating and thankfully there are many professionals involved in the process of these changes. For most people, these technical changes will have little or no meaning; but for those who suffer from mental illness, these changes could affect their treatment and their ability to get reimbursed for medical expenses pertaining to psychological services.

The discussions about these proposed changes are being openly debated on-line and in many professional circles, so ultimately, there will be very few surprises when the new manual reaches the shelves.

- Cyndi