10 February 2010

DSM V Beta Online

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, released in 1994, is the mainstream mental health community's official classification guide to mental health issues. If you don't fit in one of the boxes in the DSM IV, almost no insurance company will cover your condition and a large share of psychiatrists and psychologists will advise you that you do not have a mental health problem.

Studies with differing methodologies have estimated that between a quarter and a half of all Americans come within a common DSM IV diagnostic category at some point in their life. Anxiety disorders and depression are some of the most common diagnoses. Bipolar disorder and schizophrenia are much more rare and overlap less with "normal" behavior, but tend to be chronic, disabling conditions.

To prevent freeloading use of the manual by non-professionals, DSM IV is usually sold in bookstores only in shrink wrap. The fifth edition, DSM V, will be officially released in 2013, but a draft is being circulated for comment through April 20 at the dsm5.org.

This window of opportunity provides outsiders with a rare chance to comment upon the changes proposed and tell the drafted that they've made mistakes. It also provides a rare moment when those who are concerned that they might have a mental health issues to review the book for their own use, and provides an opportunity for those already diagnosed to discern what impact a new set of diagnostic rules may have on them.

Early press reports on the new draft note that the DSM is always controversial because the mental health profession remains largely limited to determining if someone has a mental health condition based on subjective assessments of behavior, rather than tests and physical observations of the patent's body as is the case in non-mental health contexts, even though it is clear that many, if not most, mental health conditions have a clear biological basis.

The stated objectives of the new edition are to "make sure the manual is based on scientific evidence, is useful to clinicians, and maintains continuity with the previous edition wherever possible."

Apparently, the new DSM tends towards clumping conditions into broader categories, rather than splitting conditions into subtypes, for example lumping together "autism spectrum disorders" as degrees of the same thing, and clustering "personalities disorders" into one category rather than several. These clumping decisions are based on studies "that suggest some disorders have similar origins, symptoms and treatment but only vary in severity."

New conditions including gambling addiction and binge eating disorder have been added. Another new condition in DSM V is "temper dysregulation with dsyphoria" for "children who have bursts of rage and can be moody, anxious or irritable." This is often confused with bipolar disorder in children, leading them to receive drug treatments for bipolar disorder, but unlike bipolar disorder it kids usually grow out of it as they become adults.

A new kind of diagnosis called a "risk syndrome" is also established. A risk syndrome does not rise to the level of mental disorders themselves, but are symptoms often experienced as early signs before someone develops a mental disorder, has been added.

The unabridged dictionary size book is he definitive encyclopedia and taxonomy guide to mental health in the United States and has a wealth of scientifically, and practically relevant information, and more details to hide devils in than your average Bible. It bears a look by anyone who cares about someone who has a mental health diagnosis, might have one, or is interested in mental health generally.

The main subheadings of the online draft are as follows:

Structural, Cross-Cutting, and General Classification Issues for DSM-5

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders

Other Conditions that May Be the Focus of Clinical Attention

Among the serious tweaks to existing categories being considered is an adjustment to the diagnostic criteria for ADHD conditions.

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