Asperger's is out, but binge eating and hoarding are in as official mental disorders in the latest version of the diagnostic bible published by the American Psychiatric Association, following a weekend vote by its board.
The Diagnostic and Statistical Manual of Mental Disorders -- whose latest edition is nicknamed DSM-5 -- is often called the "bible" because it's used to identify and classify mental disorders.
The vote gives only a hint of the massive changes that will be unveiled in detail in May when the guide is published. The last full revision was in 1994, with minor changes approved in 2000.
The revisions have been considered for more than a decade. Among the changes:
Eliminating the mild form of autism known as Asperger's syndrome per se and including it as part of the autism spectrum disorder;
Adding binge eating, hoarding and disruptive mood dysregulation disorder. The mood disorder would diagnose children who experience outbursts at least three times a week for more than a year.
The impact of this vote is far-reaching; decisions about what's a mental disorder and what's not affect millions of individuals across the USA, extending to what treatments health insurance will cover and which conditions schools recognize for special services.
Geraldine Dawson of the group Autism Speaks says it will be important to closely monitor these changes. "We want to make sure that no one is excluded from obtaining a diagnosis and accessing services who needs them," she says.
Psychiatrist David Kupfer, chairman of the DSM-5 Task Force, says the new version will include about the same number of conditions as the previous one, challenging critics' claims that the DSM-5 would "pathologize" behavior by increasing the number of behaviors considered mental disorders and medicating needlessly.
"It overmedicalizes human distress," says psychologist Frank Farley of Temple University in Philadelphia, who is among those leading an effort for an International Summit on Diagnostic Alternatives next year as a response to the DSM-5.
Psychiatrist Allen Frances of Coronado, Calif., who chaired the task force for the 1994 revision of the manual, is worried about such repercussions.
"The issue isn't how many diagnoses you have," he says. "The issue is how many new people will be diagnosed."
Kupfer says, "I don't believe we will have radically changed the prevalence."
He says it is a "myth that we are pathologizing normal behavior."
"I think that's frankly just not true," he says.
Several of the proposals have been particularly controversial, such as changes related to autism, as well as those for post-traumatic stress disorder and the line between normal grief and depression.
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