Skin-picking disorder, hoarding disorder and disruptive mood dysregulation disorder are just a few of the new mental disorders that will be added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) next year.
The DSM is the manual that mental health professionals use to diagnose specific mental health disorders.
The American Psychiatric Association Board of Trustees approved the final revisions to the new DSM on Dec. 1, 2012, and the new manual will be released in the spring of 2013, according to a press release from the APA.
One of the major changes to the DSM that has been causing a widespread discussion is the newly named “autism spectrum disorder.” In the current DSM-IV-TR, there are separate diagnoses of autistic disorder and Asperger’s disorder.
William Shryer, a licensed clinical social worker, said that many people are concerned that Asperger’s disorder will no longer be covered by insurance companies, so many former patients will suffer. However, he states that there is no real reason to believe this, and most likely health insurers will use the already existing code.
Dr. John Oldham, senior vice president and chief of staff at The Menninger Clinic, contributed to changes in the DSM and is a past president of the APA.
He said in an email that the goal of the new edition of the DSM is to lead to more accurate diagnoses and more effective treatment for psychiatric disorders.
Although the changes might make a big impact for some patients, for mental health professionals it could be business as usual.
“For very competent clinicians, the changes really mean nothing as this is more for insurance companies than the folks in the trenches doing the work,” Shryer said. “We shouldn't be treating labels but concerns and symptoms in the patients we see.”
Most of the revisions to the DSM could affect both men and women equally, but one change could solely impact women. Premenstrual dysphoric disorder (PMDD) will now be in Section 2 instead of the appendix, which makes it an official coded diagnosis, Oldham said.
“The research carried out through the years was judged to strongly justify this change, and the hope is that women with this condition can more easily receive treatment and, potentially, insurance coverage for that treatment,” Oldham said.
Binge-eating disorder was also moved from the appendix to Section 2, and it is thought to affect both men and women about equally.
One of the more controversial new diagnoses is disruptive mood dysregulation disorder (DMDD). Oldham said that there has been an increase in children diagnosed with bipolar disorder, which is generally treated with medication. However this new disorder appears to potentially be a better diagnosis for children instead of bipolar disorder.
Shryer believes the new DMDD could lead to pathologizing of normal behavior, including temper tantrums caused by poor parenting.
Another change in the DSM is the removal of the bereavement exclusion in the diagnosis of major depressive disorder (MDD). He said this revision will allow people to get help if a major depressive episode is triggered by the loss of a loved one.
“This in no way means that people experiencing normal bereavement would be inappropriately diagnosed, since they would not meet the criteria for a depressive illness,” Oldham said.
He added that he doesn’t believe the changes in the DSM will affect health insurance coverage greatly, but it’s hard to predict what will happen. He said some coded diagnoses will change and new ones will be added, but the new DSM has fewer overall diagnoses than the previous edition.
Rachel Thomasian, a licensed marriage and family therapist, said she has noticed many of her clients suffer from skin-picking issues, and that new diagnosis could allow for better treatment and coverage.
“I believe because it is not a current diagnosis, it often gets pushed aside and the more prominent (existing) diagnosis is focused on,” Thomasian said. “I think there is also a lot of shaming because these individuals have never heard of this being a problem, so it takes them a while to come forward with it.”
American Psychiatric Association. On December 1, the APA Board of Trustees approved the DSM-5. PDF. Web. Dec. 5, 2012.
Oldham, John. Email interview. Dec. 5, 2012.
Thomasian, Rachel. Email interview. Dec. 4, 2012.
Shryer, William. Email interview. Dec. 5, 2012.
Reviewed December 6, 2012
by Michele Blacksberg RN
Edited by Jody Smith