DSM-5, an update to one of the most important manuals in mental health – known as the bible of psychiatry – is to be published later.
Controversy and criticism has surrounded work on the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Some say the rulebook will turn normal behavior, like grief or childhood temper tantrums, into mental illness.
The manual is used mainly in the US, but is influential around the world.
This is the first update to the volume since 1994. Experts in mental health have been taking account of the latest scientific developments to update ways of diagnosing mental disorders.
The exact changes will be presented at a meeting of the American Psychiatric Association (APA).
There will be new categories including binge eating disorder, disruptive mood dysregulation disorder and hoarding disorder. Meanwhile Asperger’s syndrome will become part of autism spectrum disorders rather than having a section of its own.
The publication will have no effect on how people are diagnosed in countries which use guidelines from the World Health Organization (WHO).
Controversy and criticism has surrounded work on the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Prof. Peter Kinderman, head of the Institute of Psychology at the University of Liverpool, said: “[DSM-5] will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.”
He said “normal grief” would now be classed as a major depressive disorder and childhood temper tantrums would be a symptom of disruptive mood dysregulation disorder.
Also: “A wide range of unfortunate human behaviors, the subject of many new year’s resolutions, will become mental illnesses – excessive eating will become <<binge eating disorder>>, and the category of <<behavioral addictions>> will widen significantly to include such <<disorders>> as <<internet addiction>> and <<s** addiction>>.”
There is also criticism of the way DSM classifies diseases based on symptoms. There are efforts to harness advances in genetics and neuroscience to diagnose people based on the cause rather than the symptoms of the illness.
The director of the US government’s National Institute of Mental Health said DSM had a “lack of validity”.
Dr. Thomas Insel posted a blog saying: “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.
“In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”
In some areas the distinction between disorders is narrowing. Autism, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia are all classed as separate disorders based on their symptoms.
However, research published in the Lancet medical journal in February showed all five disorders shared several genetic risk factors.
Dr. David Kupfer, the chair of the DSM-5 task force, said: “The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care.
“We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research.”
Autism affects the ability to think, communicate and socially interact and affect one in 110 US children
The risk of an autism spectrum disorder occurring in a younger brother or sister was estimated to be from 3% to 14% in the past years. However, researchers have now discovered this is close to 19%.
“The average risk for the whole sample was 18.7%,”
said researcher Sally Ozonoff, PhD, Vice Chair for Research and professor of Psychiatry and Behavioral Sciences at the M.I.N.D. Institute at the University of California Davis.
Dr. Sally Ozonoff, PhD, professor of Psychiatry and Behavioral Sciences at the M.I.N.D. Institute
“Certain children had an even higher risk,” Dr. Ozonoff said.
”Families who had male infants had a higher recurrence of 26.2%.”
”Families that had more than one child with autism prior to the birth of this infant [in the study] had almost a one in three risk, or 32%.”
“Overall we found this almost 1 in 5 risk, but more like 1 in 4 if the new baby was a boy and 1 in 3 if the family has more than one child with autism.”
The results are published in Pediatrics.
[googlead tip=”vertical_mare” aliniat=”dreapta”] This new information may help parents in their family planning decisions or make them aware of an early intervention at the younger sibling.
“This was very sad, it brought tears to our eyes for many of us,” Dr. Sally Ozonoff said.
“However, the information is valuable. Parents can ask for close monitoring of a young sibling. That way, if autism is detected, early intervention can begin. The new information may also help parents in their family planning decisions.”
During the study have been evaluated 664 infants who were enrolled in an international network known as the Baby Siblings Research Consortium. All enrolled infants had an older sibling with an autism spectrum disorder.
They were observed from about 8 months of age until 36 months. The infants were evaluated many times during the three years.
At the 36-month mark, the infants were classified as having an autism spectrum disorder or not.
Study findings showed at the end that 132 children out of 664 were diagnosed with an autism spectrum disorder. Out of those 132, about 41% were diagnosed with autism and 59% were diagnosed with other conditions on the spectrum, such as Asperger’s syndrome.
According to Dr. Ozonoff, it is impossible to estimate an individual family’s risk.
“Remember that overall, over 80% of those babies didn’t have autism,” she said.
“The general population risk is under 1%.”
“The new estimates are very sound,” said Laura Schreibman, PhD, director of the Autism Intervention Research Program at the University of California, San Diego, who reviewed the study findings but was not involved in the research.
“The study design, which followed the infants forward, ensures more accuracy than looking backward,” Dr. Schreibman said.
“The fact that they could look ahead meant they could be certain about how the diagnoses were obtained.”
The group included children from 12 locations and was ethnically diverse. Both of these factors reduce bias.
“Families need to know this is an estimate,” Dr. Laura Schreibman added.
“It doesn’t reflect what will happen to an individual family.”
“This new study provides a more definitive estimate of the recurrence of autism in younger siblings,” said Alycia Halladay, PhD, director for environmental research for Autism Speaks.
Autism Speaks supports the Baby Siblings Research Consortium.
Autism Speaks, the National Institutes of Health, and other organizations supported the study.
“For parents who have an older child with autism, the new information should motivate them to be sure the younger child has close monitoring,” Alycia Halladay said.
“That should be done as early as six months,” she added.
[googlead tip=”lista_mare” aliniat=”stanga”]“Genetic counselors can use the information to help parents interpret the findings,” said Karin Dent, president of the National Society of Genetic Counselors and assistant professor of pediatrics at the University of Utah, Salt Lake City.
“The updated data from this study … should be incorporated in genetic counseling sessions with parents and families of affected individuals,” Dr. Dent said.
“This will help families to have a number on something that is difficult to assess.”