Psychiatrys main professional group has voted to redefine how some mental disorders are diagnosed, including autism, in a manual used by doctors to treat patients and by insurers to determine payments.
The move comes after a 7-year debate that has split the mental health community over whether the changes will spur over- diagnosis of some disorders, and limit treatment for others. The guide collapses several conditions into a broadened definition for autism. It also adds new maladies, including one called disruptive mood dysregulation disorder for children who have temper tantrums at least three times a week.
The vote yesterday by the American Psychiatric Association was alternately called a disaster by Allen Frances, who led work on the previous version, and a conservative document by David Kupfer, who led the panel that presented the latest edition. The guide is scheduled to be released in May at the psychiatric groups annual meeting.
I think weve improved our diagnostics, but this is not written in stone, Kupfer said in a telephone interview after the vote. The committee that produced the new edition will monitor how the changes play out, he said.
The Diagnostic and Statistical Manual of Mental Disorders is the standard used by mental health professionals for diagnosing illness and for research. The newest edition, referred to as DSM-5, is meant to incorporate research in the 18 years since the previous major revision was completed in 1994.
A panel of experts from 90 universities worldwide revised the manual, at a cost expected to be about $25 million. One in 5 Americans experienced some form of mental illness this year, the U.S. Substance Abuse and Mental Health Services Administration reported in January. Mental health-care costs rose 63 percent to $57.5 billion in 2006 from a decade earlier, according to the National Institutes of Mental Health.
Public criticism on the manual has grown over the last two years. A division of the American Psychological Association in Washington posted an open letter to the DSM panel a year ago that was signed by more than 14,000 people, including psychologists, counselors, and community activists.
In many cases, family doctors that dont have extensive training in mental disorders will be using the new definitions, Frances said in a telephone interview after the vote was taken. The thing I learned with DSM-IV is that if anything can be misused, it will be, he said.
Among the revisions is a decision to collapse several conditions, including Aspergers syndrome and child disintegrative disorder, into a single autism diagnosis.
Critics have said that the elimination of Aspergers as a unique diagnosis may limit access to care for some high- functioning people who previously might have been diagnosed with the syndrome. A study presented at a medical meeting in Iceland in January suggested that as many as half of the high- functioning patients who had been diagnosed under the previous rules may be missed by the new ones.
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Psychiatrists Redefine Disorders Including Autism