SAN FRANCISCO--The American Psychiatric Association gave its final approval to the latest guide to psychiatric disorders, despite strong criticism that it created new mental disorders when none exist and could lead to misdiagnosis and unnecessary medication.
The first rewrite in 20 years of the diagnostic Bible of psychiatry was approved in the midst of heated controversy. The guide, known as DSM-5, defines a host of symptoms that are categorized to help doctors identify specific mental disorders. But what is defined as a mental disorder can be very controversial.
In the 1970s, homosexuality was dropped as a mental illness from the DSM-4, prompted by the leading force in its revision, Allen Frances, MD, now a leading critic of the latest version and a professor emeritus at Duke University.
“Dangerous” Changes from Grief to Asperger’s
"New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs -- often by primary care doctors after brief visits," Frances said in a Psychiatry Today editorial.
Among the most dangerous of the changes, according to Frances, is casting temper tantrums as a mental disorder, now called Disruptive Mood Dysregulation Disorder, or DMDD. He fears it will add excessive and inappropriate use of medication on young children.
And treating normal grief from the loss of a loved one as a Major Depressive Disorder, could affect many older Americans when they lose a spouse or relative. Frances said the creation of a mental disorder around grief trivializes it and invites overuse of medical in place of seeking consolation from family, friends or religion.
One of the most hotly debated changes has been the definition of various ranges of autism. It drops the specific diagnosis of Asperger's syndrome.
People with the disorder are often of high intelligence and vast knowledge on narrow subjects but lack social skills. Some Asperger's families objected to the change, fearing their children would no longer be eligible for special services.
Asperger’s also has been mentioned in connection with Connecticut school assailant Adam Lanza. News reports indicate that Lanza may have had the condition, although researchers have found no connection between violence and autism or Asperger's.
Frances also warned that everyday forgetfulness among elders may now be misdiagnosed as Minor Neurocognitive Disorder, creating false positives for a group of people who may fear they are at risk for dementia, when they are not.
"The label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia," he said.
Overeating 12 times in three months may now be labeled as an illness called Binge Eating Disorder, he warned.
Although 50 mental health professional associations petitioned the members of the DSM-5 committee for outside review of the diagnostic guide, it was rejected.
Faced with outside pressure, members of the revision committee did abandon some of the more controversial changes, including listing rape as a mental disorder, as well as Internet and sex addiction, and dropping sharply lowered thresholds for existing disorders, he said.
The full details of DSM-5 will be released in May 2013 when it is published in its final version.
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