Eating disorders, autism, and substance abuse are among the conditions for which the American Psychiatric Association is proposing changes in the fifth edition of its diagnostic bible, posted online. If you are labeled with "risk disorder," you diagnosis becomes treatable with a drug, and you might eventually lose health insurance or the chance to find a job. The public has a voice. See, the American Psychiatric Association site. Check out, "DSM-5 Draft Criteria Available Online."
Since Feb. 10, 2010, the resulting recommendations for revisions to the current DSM have been posted on the APA’s Web site for the manual, , for public review and written comment. These comments will be reviewed and considered by the relevant DSM-5 Work Groups.
According to a Feb. 10, 2010 Washington Post article by Rob Stein, "Revamping manual of mental disorders spurs fierce debate," the updating in 2013 of the manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM), possibly could have far-reaching implications such as preventing you from getting long-term care insurance if you were deemed to be genetically at risk for dementia, for example.
The Diagnostic and Statistical Manual of Mental Disorders, or DSM, determines how mental disorders are diagnosed. It also influences research and what is going to be researched. But it also opens the door to new drugs to treat the new diagnostic labels of what formerly might have been normal behavior along a spectrum.
For kids, a child with too many tantrums would no longer be called frustrated or trying out his/her willpower on parents but instead would be labeled as having "temper dysregulation disorder." You no longer have the terrible twos. Your kid has a temper disorder.
An introverted teenager would no longer just be focused on specializing rather than generalizing, but instead might be labeled with a diagnosis of having "psychosis risk syndrome." This opens doors for drug treatment to make the teen less eccentric, for example.
New recognition of binge eating disorder and improved criteria for anorexia nervosa and bulimia nervosa, as well as recommended changes in the definitions of some eating disorders now described as beginning in infancy and childhood to emphasize that they may also develop in older individuals. See the Feb. 10, 2010 press release, "APA Announces Draft Diagnostic Criteria for DSM-5."
A person too interested in sex with a partner might be diagnosed with having "hypersexual disorder." All these disorders that didn't exist before as labels to prime people for psychiatric drug treatments open doors to the large pharmaceutical corporations to find new labels of diagnoses to "drug down" with new drugs. For those with less interest, there's the label hyposexual disorder. Is it really a disorder or simply a preference or choice?
If your brain reacts with anxiety when you eat wheat, because you might have a brain allergy, you won't have a brain allergy to wheat anymore, but a mental disorder, if the new manual decides to include such a diagnosis.
These definitions of mental disordrs are among many being aired as proposals by the American Psychiatric Association. The APA is revising its' DMA, the first revision since 1994. This book that defines a whole slew of mental disorders is the 'bible' for modern psychiatry.
Will the new revision in three years be set up so psychiatrists will be able to sell more drugs to fit the labels? The manual is the product of ten years of research by many experts.
The revisions are supposed to bring the best scientific evidence to be applied to psychiatric diagnoses. The result is to decide who should get the powerful psychotropic new drugs. But more importantly, the new manual will tell insurance companies whether or not and how much to pay for your healthcare.
The new diagnoses will impact how you see yourself. Are you normal, eccentric, quirky, or mentally disordered and in need to be drugged into complacency?
The manual also influences what areas of medicine are researched. The new manual will affect you legally. It will influence industry, whether you get hired or not, and whether you get insurance. It also will affect how much money government programs will give for research or other programs related to mental health and mental disorders.
The new manual could lead to you being stigmatized by health insurance firms, by your employer or potential employers, and how the pharmaceutical industry will impact your needs.
Patient advocacy groups, pharmaceutical corporations, doctors, the government, and insurance companies all will be influenced by changes in what label is put on you personality quirkiness, eccentricity, or mental disorder.
The idea is to find which personality traits 'society' considers as mentally disordered on the spectrum of emotions and behavior. The manual will define what's pathological, requireming drugs or simply talk therapy or expressive therapies. The manual might also influence what society considers as criminal behavior in need of punishment and rehabilitation versus training and a change of diet.
The proposed changes are the subject of debate. So far no one really knows whether the changes are the result of realistic scientific evidence. Maybe the pharmaceutical industry influenced the definitions so more drugs might be sold?
The debate focuses on how much financial interests of drug companies are at stake. Should health care professionals look at the old or the upcoming new diagnostic definitions of mental disorders?
Who's to say what's normal behavior on a spectrum of personality traits? Will the revision make diagnoses a lot more accurate than it is today? Will the definitions be more precise?
On the autistic spectrum, for example, Asperger's syndrome would be eliminated. Instead, there would be a single category called "autism spectrum disorders."
But spectrum disorders might be applied to a lot of other diagnosis, for example, introversion or other diagnoses such as fear of public speaking or obsessive behavior.
The problem is that new diagnoses stigmatize more people that in the past were just called eccentric, solitary, overly devout, or shy. On one hand, people with hair-trigger tempers need to have some anger management control to lighten up, but are drugs the answer?
The big fear is the overuse of psychiatric medicines to increase the income of the pharmaceutical companies. Another fear is the applying more pathologies to the masses. The verb is "pathologizing" individuals.
By creating more diagnoses of mental quirks, you send people down a path that leads to more and more drugging. Maybe the individual only needed a change of diet. For example, the person could have a brain allergy to wheat.
If you're experiencing distress that formerly was labeled as normal grief or anxiety, should you be drugged, put on a diet that better manages the stress hormones, or listen to calming music?
A public comment period lasts until April 20th. The final version of the new manual won't be published until May, 2013. So there's time for public input on the matter.
Are you ready to be overdiagnosed and micromanaged? Or are you in favor of scientists finding out how much psychopathology really exists in society? And is pathology in one society different than what would be normal in another society or culture? How will the decisions be made?
What's the risk syndrome? How would teenagers with odd ideas be diagnosed? How do you feel about a proposal to create a new condition for people at risk for dementia? What happens if you're denied long-term care insurance because of the creation of a new condition that puts you at risk?
New conditions such as temper disregulation dysphoria (TDD) puts you in the category of having a mental disorder. How will your health insurance company look at that diagnosis? And what happens when too many kids are being treated for bipolar disorder? Should the new diagnosis be specific?
It's the job of the APA to prevent controversy. What's happening is that normal behavior is now a sickness that needs to be treated with drugs. But is anyone looking at a dietary, nutrition-based cause to food-based brain allergies?
Proposals for diagnoses of new mental disorders include labels such as binge eating, gambling addiction, normal grief when a family member dies gets labeled as drug-treatable depression, and Internet addiction becomes a mental disorder. All these terms may become mental disorders treatable with specific psychotropic or anti-anxiety drugs instead of changes in foods, more exercise, or talk, behavior, and music therapies.
Other proposed changes include replacing substance abuse and dependence with "addiction and related disorders." "Dependence," the normal tolerance and withdrawal some patients have when taking prescribed painkillers, often is confused with addiction. What if you don't have an addiction? Is your problem instead related to undertreatment of pain? Or do you need pain control drugs that you are becoming addicted to?
Are you a binge eater? That will be classified as a specific disorder. But what if you think you're normal when you eat a large amount of food once in a while and feel embarrassed by your sweets, meat, cheese, or chocolate cravings? Stress eating will be a disorder now. The disorder will be especially targeted to label women that are more likely to reach for high-fat foods. The new label will be called "stress eating."
A new category of "behavioral addictions," which includes only gambling will probably be added. But Internet addiction was considered, and it was decided that more research is needed. For further information see the Feb. 8, 2010 USA Today article by Rita Rubin, "Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM'."
The four most addictive foods are sugar, chocolate, cheese, meat, and dairy products. Will they be classified as food addictions? It's up to the APA for a final decision, but there's time for the public's input. Also see, "Is there an ecological unconscious?"