After 13 years of discussion and revision, involving over 1,500 mental health experts, the American Psychiatric Association (APA) has finalized the new version of the Diagnostic and Statistical Manual of Mental Disorders. There will be a final vote on the changes in the spring of 2013, which will include all APA members; those in the know about the process believe that the current changes will remain.
This manual is basically the bible used by all mental health professionals to make diagnoses using specific criteria and codes. Those codes can then be used to get reimbursed by insurance companies or to apply for special services for their patients. Therefore the changes that have been made will have a substantial impact on a large number of people and are likely to cause a considerable amount of heated discussion.
Clinicians have debated over the years about whether or not to include or exclude certain diagnoses, and their arguments typically stem from their own clinical philosophy. Some have even charged that the process is very political and that the inclusion of certain categories will be a tremendous moneymaker for the APA. Some of the changes will give clinicians the ability to bill insurance for treatments that were not reimbursable in the previous versions of the DSM.
A major change in the new version will be the inclusion of Asperger’s Syndrome into the newly named Autism Spectrum Disorder. This particular change has garnered a great deal of criticism because Asperger’s in considered much less severe than many forms of Autism but this inclusion will help those with a diagnosis of Asperger’s access a number of valuable services.
There will also be a completely new diagnosis added to the book pertaining to children. In an effort to avoid the over diagnosis of bipolar disorder in kids, the APA has created Disruptive Mood Dysregulation (DMDD.) This term will be used to describe kids who exhibit “persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.” The obvious concern around this new label is that what constitutes a tantrum could be somewhat subjective and children are diagnosed based on parental report which is also relatively subjective. My concern would be that this new label will become a dumping ground for behaviors that can’t be explained clearly and don’t neatly fit into another category. It seems to me to be too broad a description, which warrants further study, and would be better suited for a place in the appendix with other provisional diagnoses. Many other clinicians share these concerns.
There is no perfect solution to revamping this mental health guidebook and most professionals agree that it was overdue for a change, but some of the changes that have been made do seem to be motivated by something other than psychological theory. The unfortunate reality, which no one can deny, is that healers, both physical and psychological, are in a business and at times that fact can muddy the waters when it comes to making decisions that are truly in the best interest of their patients. No matter how this new version the DSM ultimately turns out, one thing that is certain is that the professionals who use it will continue to debate the validity and accuracy of its content for many years to come.
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