Don't say "mental retardation" -- the new term is "intellectual disability." No more diagnoses of Asperger's syndrome -- call it a mild version of autism instead. And while "behavioral addictions" will be new to doctors' dictionaries, "Internet addiction" didn't make the cut.
The American Psychiatric Association is proposing big changes today to its diagnostic bible that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback online from psychiatrists and the public about whether the changes will be helpful.
The manual suggests some new diagnoses. Gambling so far is the lone identified behavioral addiction, but in the new category of learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don't purge.
Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders -- such as dementia or schizophrenia -- based on early symptoms, even though there's no way to know who will worsen into full-blown illness. It's a category that the psychiatrist group's own leaders say must be used with caution.
Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.
But overall, the manual's biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses -- and urge doctors to concentrate more on the severity of their patients' symptoms. Thus the draft sets "autism spectrum disorders" as the diagnosis that encompasses a full range of autistic brain conditions.
The psychiatric group says it expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.
Psychiatry has been accused of overdiagnosis in recent years as prescriptions for antidepressants, stimulants and other medications have soared. So the update of this manual called the DSM-5 -- the Diagnostic and Statistical Manual of Mental Disorders, fifth edition -- has been anxiously awaited. It's the first update since 1994.
"The field is still trying to organize valid diagnostic categories. It's honest to re-look at what the science says and doesn't say periodically," said Ken Duckworth, the medical director for the National Alliance for the Mentally Ill, which was gearing up to evaluate the draft.
The draft manual, posted at www.DSM5.org, is up for public debate through April, and that debate is expected to be lively.
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