DSM makes it official: Asperger's is out, binge eating is in

DSM-V will be published in May

The American Psychiatric Association's (APA) Board of Trustees over the weekend voted to approve the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as DSM-V.

According to APA, DSM-V—which will be published in May—was created with input from more than 160 clinicians and researchers, as well as help from hundreds of other clinical investigators and comments from health professionals and the public during open-comment periods. The guide will include several changes proposed from DSM-IV, which was last revised in 1994.

The revisions include:

  • Combining subcategories of autism and related disorders, including Asperger's syndrome and "pervasive developmental disorder, not otherwise specified," into a single category of autism spectrum disorder;
  • Creating a new diagnosis of disruptive mood dysregulation disorder for children who have frequent behavioral outbursts, offered as an alternative to diagnoses of pediatric bipolar disorder;
  • Recognizing hoarding, post-traumatic stress, and binge eating disorders;
  • Combining the current categories of substance "abuse" and "dependence" into a single category of "substance use and addictive disorders";
  • Altering the way individuals are diagnosed with a substance use or addictive disorder by using an 11-item list, with rankings that would determine if they have no disorder, a mild disorder, a moderate disorder, or a severe disorder;
  • Removing an exclusion for "bereavement" in the depression category that prevented people in mourning from being diagnosed with depression; and
  • Adding a "section 3" for conditions that require additional research before they are considered true diagnoses, including Internet gaming disorder, attenuated psychosis syndrome, suicidal behavior disorder, and non-suicidal self-injury.
  • Related: DSM-V panel proposes expanded definition for 'addiction'

According to the Wall Street Journal, the changes could have far-reaching implications for millions of U.S. residents and billions of health care dollars, because the DSM determines who qualifies for subsidized health care services, treatment programs, and insurance reimbursement.

Some experts are concerned that the new autism criteria might exclude children currently diagnosed with ASD, estimated to be one out of 88 U.S. children. In a statement, Geraldine Dawson—chief science officer for Autism Speaks—said the group is "concerned about the impact of the new DSM-V criteria when they are used in real world settings."

In addition, Temple University psychologist Frank Farley said the new DSM "overmedicalizes human distress." 

Psychiatrist David Kupfer—who led the revisions task force—called concerns that the new DSM would "pathologize" human behavior a "myth" (Gever, MedPage Today, 12/1; Jayson, USA Today, 12/2; Beck, Wall Street Journal, 12/1).

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