Tag Archives: american psychiatric association

Some fear DSM update opens door for exploitation

On All Things Considered, NPR’s Alix Spiegel looks to the past and future to ferret out the potential drawbacks and benefits of the expanded psychiatric diagnoses proposed in the upcoming revision of the American Psychiatric Association’s Diagnostic and Statistical Manual.


Photo by Richard Masoner via Flickr

Spiegel begins with the forceful perspective of Allen Frances, the man who edited the last update of the DSM. From Frances, Spiegel pulls a few cautionary tales of the unintended consequences of changing DSM entries.

The first? Aspergers.

It’s a disease that needed to be diagnosed, Frances says, but it’s now massively overused because of the unforeseen “unintentional incentive” created by schools that offer greatly expanded educational resources to children diagnosed with Aspergers.

“And so kids who previously might have been considered on the boundary, eccentric, socially shy, but bright and doing well in school would mainstream [into] regular classes,” Frances says. “Now if they get the diagnosis of Asperger’s disorder, [they] get into a special program where they may get $50,000 a year worth of educational services.”

Another cautionary tale? Bipolar disorder. The last DSM revision made it a far easier diagnosis to get. In essence, this easier diagnosis opened a gaping door in medicine, one which pharmaceutical companies quickly muscled through.

“Drug companies got indications for treating bipolar disorder,” Frances says. “Not just with mood stabilizers, but also with the newer antipsychotic drugs. And they began very intensive ubiquitous advertising campaigns. So the rates of bipolar disorder doubled. And lots of people got way too much antipsychotic and mood stabilizing medicines. And these aren’t safe drugs.”

For the other side of the story, Spiegel spoke to a psychiatrist who argued that broadening diagnoses means that fewer of the mentally illl go undiagnosed, and that diagnoses are delivered earlier than they would be otherwise. Furthermore, he believes that adding illnesses to the DSM will spark research and investment toward treating those ilnesses.

Comments invited on latest draft of DSM

A new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has come out every decade or so (it varies widely) since 1952. dsm-5It hasn’t substantially changed since 1994, but the next revision is slated to come out in 2013. It’s a pretty big event, as the book’s diagnostic criteria are used around the world to determine who is diagnosed with mental disorders.

With the release of the new version, lines may shift and folks who were diagnosed with mental disorders may find themselves “undiagnosed.” Others will have labels changed and gain labels they didn’t have before.

The latest draft proposal of the May 2013 revisions, upon which public comment will be accepted until April 20, 2010, was posted on Feb. 9. APA workgroups will review the comments and begin trials soon after. Benedict Carey rounded up and evaluated some of the biggest proposed changes for The New York Times. In addition to bipolar disorders in children and autism spectrum disorders, Carey discusses the sheer significance of the changes.

“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.

“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”