The fifth edition of the American Psychiatric Association's manual of mental disorders is finally out, offering the latest revision in nearly 20 years of the diagnostic bible used by individuals and agencies, insurers, schools and government bodies to navigate the mental health landscape.

But just as it’s birthed, the new Diagnostic and Statistical Manual of Mental Health Disorders -- widely known as the DSM-5 -- is under attack by prominent critics, including the chairman of the task force that created the last version.

Dr. Allen Frances, who led efforts on the DSM-4, minces no words in describing the new 1,000-page tome that’s part guide, part dictionary for theorists and practitioners alike.

“My advice for people is not to buy the DSM-5, not to use it, not to teach it,” Frances told NBC News. “I do not think it will be useful for those endeavors.”

He suggests that doctors and everyone else use the International Classification of Diseases instead.

The psychiatric society is releasing the manual early Friday in advance of a meeting in San Francisco. Its backers say it offers better organization and more precise diagnoses than its predecessors.

“The changes to the manual will help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care,” said Dr. David J. Kupfer, chair of the DSM-5 task force, in a statement. "We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research."

But Frances and other critics say the new manual too often turns normal reactions to life events into diagnosable mental conditions.

Earlier this week, Dr. Thomas Insel, director of the National Institute for Mental Health, declared that the DSM-5 lacked “validity” because its diagnoses lack objective standards and measures.

Grief is one of several examples, said Frances, who has written a book about his objections called “Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.”  

“It staggers the imagination!” he said. “In two weeks after the loss of a person you love, if you are still feeling these symptoms: loss of interest, reduced appetite, trouble sleeping, less energy, it qualifies as major depressive disorder. Now it becomes a target of a drug company.”

Thanks to DSM-5, Frances said, a drug company representative could go to primary care doctors – who do the majority of psychotropic drug prescribing in the United States -- and market an anti-depressant based on this new DSM criteria and not be illegally marketing the drug off-label.

“This is the legalized conversion of a sacred ritual and an inherent part of being a mammal – mourning -- and turning it into a mental disorder,” he said. 

Others have criticized the new guide for turning extreme childhood temper tantrums into a diagnosable condition -- “disruptive mood dysregulation disorder” -- while removing Asperger’s disorder as a separate diagnosis, folding it into the overall “autism spectrum disorder.”

The APA strongly disagrees with Frances' criticisms. Dr. Jeffrey Lieberman, APA’s president-elect and the chair of the department of psychiatry at Columbia University, said personal slights and self-interest are part of the motivation behind Frances’ position.

Leaders of DSM-5 “treated him disrespectfully” Lieberman said, “and it provoked him.”

Attacking DSM-5 gives Frances a “new platform to become the savior of normal – that’s his book -- saving society from those irresponsible psychiatrists and the DSM,” he added.

Medical diagnoses of all kinds have expanded over the last 100 years as science gained new knowledge, Lieberman argued, pointing out that in the 1800s, there were only two mental health diagnoses: idiocy and insanity. The new volume recognizes those advances.

Arthur Caplan, the director of medical ethics at New York University’s Langone Medical Center, and a frequent contributor to NBC News, believes the controversy over new DSM criteria is misplaced.

Just because something is common, or natural, like acne and tooth decay, doesn’t mean it shouldn’t be named as a condition. While Caplan agreed that there are abuses of diagnosis, medications and treatments, it’s not necessarily DSM’s fault. Even if something is diagnosable, he said, both doctors and patients are often too tempted to treat when doing nothing might be best.

The problem isn’t with the new manual, but with a culture that demands a quick fix, making it easy for general practitioners, who may not see the same patient week after week, to accede, said Gail Saltz, a psychiatrist, psychotherapist and TODAY Show contributor. That can lead to over-diagnosis and, worse, overtreatment.

What matters isn’t necessarily what the DSM says, but “are your symptoms impairing your functioning?” she explained.

“If ‘Internet Addiction’ is in the DSM matters less than if you are sitting in front of a computer eight hours every day, because then you’re not functioning.”

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

Related:

• No 'crazy cat ladies': Hoarding gets new diagnosis
• Asperger's being dropped from psychiatrists' guide

Could little Johnny, that kid who always seems to be in trouble for hurting other children, be a psychopath in the making? Or is he just rambunctious? And if he’s at risk of becoming a future psychopath, could science catch it early, and head off a life of trouble?

A new study from British researchers suggests this may one day be possible. 

Adult psychopaths are known to be unable to place themselves in the position of those they hurt. They have little or no empathy. They can’t “feel your pain."

But “there is a lot of variability among children with conduct problems,” one of the researchers, Essi Viding, professor of psychology at University College London’s Institute of Cognitive Neuroscience, told NBCNews.com. 

The study, published Thursday in the journal Current Biology, gathered a sample of 37 boys verified by surveys completed by teachers and parents to have serious conduct problems such as causing harm to others and uncaring attitudes toward others, and a control group of 18 boys who did not. The boys were aged 10 to 16.

The boys were placed in a functional magnetic resonance imaging (fMRI) machine that depicts which areas of the brain are active in response to a stimulus. The boys were shown a series of 192 photos of hands and feet in pain, or no pain, situations. For example, an image might show a hand resting on a table top with a knife laying beside it, or the same hand on the table with the point of the knife blade about to pierce it.

As a group, the boys with serious conduct problems tended to show decreased activation in areas of the brain -- especially the anterior cingulate cortex, and the insula -- that are critical for empathy for pain, in comparison to the control group of boys.

With lower empathy, they were less reactive to others’ pain. This could be the root of what the researchers call “callous traits.”

Reduced response to pain of other people, the researchers wrote, “could reflect an early neurobiological marker indexing risk for empathic deficits seen in adult psychopathy.”

If that sounds a little scary, like the Philip K. Dick novel “Minority Report” (made into a movie by Steven Spielberg in 2002), in which crime is predicted and future wrongdoers labeled and arrested before they offend, Viding and others in the field stress two points: any such future is a long way off, and that’s not the goal of the research.

For one thing, fMRI studies of psychopathy have yielded a variety of results, sometimes conflicting ones. Last month, for example, a study published in the journal JAMA Psychiatry by Jean Decety of the University of Chicago, a leading expert in the field of social neuroscience, found that incarcerated men with psychopathic traits had greater activation of the insula region in response to images of pain – the opposite of what Viding’s group found.

There could be a number of reasons for conflicting results, suggested Abigail Marsh, a Georgetown University professor of psychology. A recent Marsh study published in the Journal of Child Psychology and Psychiatry tracked with the Viding team’s results – reduced response from brain regions key to empathy. But, she said, “we found a very small change in instructions” – to imagine the person in a picture is one’s self versus another person – “made a very big difference in the patterns of brain activity we observed.”

Plus there are obvious age, developmental and life experience differences between an adult incarcerated population and children.

In order to clear the fog, Decey said, “we really need many more studies of this kind.”   

Meanwhile, whatever the fine details, it is clear that the brains of psychopaths work differently than those of non-psychopaths. Psychopaths, for example, often show dysfunction in the amygdala, where fear is processed. As a result, psychopaths are bad at recognizing fear in others.

Viding agreed that “we are a very long way from reliably predicting future psychopathy by testing children. In fact, I am very skeptical about us ever being able to do so.”

But that’s not necessary to help children because the real goal is treatment, not pinpointing a future serial killer. “We are hoping that, as has been the case for autism, we are able to develop earlier identifiers that will allow us to begin treatment when children are young,” Marsh said.

Research shows that if such children can be identified, behavioral therapy, such as rewarding empathetic behavior toward others, and training parents in adopting a warmer parenting style, can work, though it’s still early and, Viding said, it may always be difficult to parent such children.

No child should ever be labeled a psychopath, Viding said, because their brains and life experiences are still  developing and, especially if given intervention, they may never wind up psychopathic, but callous traits are a real problem.

“Research clearly shows that not all children with conduct problems are alike. It may sound more politically correct not to acknowledge that, but ultimately that stance is not going to be helpful for the children and their families. In my own experience, parents of children with conduct problems and callous traits are often desperate for help.” 

Related links: 

Speech patterns may give psychopaths away

Facebook profile may expose mental illness

U.S. mental health experts urge focus on early treatment

Viewing sexually explicit programs or content on websites may not truly influence whether a young adult will have risky sex or lots of partners, a new study from the Netherlands shows.

Watching porn only affects sexual behavior a little bit. It can prompt someone to be more likely to have a one-night stand or have sex for money, according to the report released Thursday in the Journal of Sexual Medicine. But other influences such as personality type, educational and family background, and poverty hold more sway than viewing sexually explicit material. The study, led by Gert Martin Hald of the Department of Public Health at the University of Copenhagen, surveyed 4,600 young people between the ages of 15 and 25 living in the Netherlands during 2008-2009.

They found that 88 percent of the young men and 45 percent of young women had viewed sexually explicit media over the past 12 months. All kinds of porn, including bondage, soft core, and violent images were included, but the influence of that porn on behavior, though scientifically significant, was small. 

The sexual behaviors were classified into three broad areas: adventurous sex such as threesomes or sex with someone met online; partner experience, such as one-night stands; and transactional sex, involving payment.  

More porn viewing was associated with a greater likelihood that young adults would say “yes” to one or more of these behaviors.  

But that’s not the end of the story. Importantly, Hald and his team also asked questions gauging traits like sexual sensation-seeking -- how driven a person is to seek new experiences -- as well as gender, age, education, religious belief, relationship status and ethnicity, self-esteem and others.

Few studies have tried to incorporate these other factors, but, Hald told NBCNews.com “associations between porn and sexual behavior or attitudes really always should be studied in conjunction with other relevant factors, such as personality.”

When all those variables were taken into account, it turned out that all those behaviors were also highly associated with the personality type of sexual sensation-seeking.

For example, Hald explained, “only 2-3 percent of our sample engaged in transactional behaviors, and the proportion of these behaviors explained by porn viewing was only 1 percent for men and 2 percent for women.” Other factors, he said, such as poverty and culture, were more important.

That was true across the board. The frequency of looking at porn explained only about .3 to 4 percent of behavior.

“This suggests that frequency of [porn] consumption is just one factor among many that may influence the sexual behaviors of young people,” the study concluded.

It’s not that porn has no effect. But many other factors are in play. For example, Hald said his Netherlands sample may differ somewhat from an American one given the Netherlands somewhat more liberal sexual cultures where, for example, prostitution is legal."I think that the social and sexual context of viewing pornography impacts the association between pornography and the sexual behavioral outcomes studied," Hald said.

Chauntelle Tibbals, a sociologist at the University of Southern California who studies the adult entertainment industry, agreed.

She pointed out that watching porn is illegal for those under 18 and that younger people who have not had much sexual experience, nor solid much sexual education, may turn to porn for sex clues. “If you did not already know about this in real life, or have sex education, or experience it with a peer, and you see it in porn, you may think, ‘Oh, I want to do that.’”

But she agreed with Hald that watching porn was only one small influence among other, larger influences.

It comes down to what’s driving the train. Hald suggested that things like age at which one first has sex, oral sex behaviors, and porn consumption are really the passengers on a train driven by personality, family, education and economic status. 

“I would say that it may likely be that personal dispositions such as sensation seeking may be what is essential,” he said. 

It’s not that watching porn has no effect. It’s that porn doesn’t exist in a vacuum. “Pornography adds to increases in the sexual behaviors and attitudes we studied, but this contribution is modest.”

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

The legal question at the heart of the US Supreme Court’s debate over the patenting of human genes has practical ramifications that could ripple into the lives of every American -- not just women at risk for rare breast cancer.

Dorothy Warburton, Ph.D./Newscom

BRCA 2 (breast cancer) gene on chromosome 13.

What the high court decides could affect who will conduct your medical tests, how those tests are interpreted, how and how fast drugs can be developed -- and what your doctor can tell you about your health, experts say.

That’s because all of those issues are entangled in the case involving a Utah company, Myriad Genetics, which controls the patents on variations of two human genes, known as BRCA1 and BRCA2. Women with mutations in those genes are at much higher risk for getting breast and ovarian cancer.

“This is important,” says patent expert Arti Rai, the Elvin R. Latty professor of law at Duke University School of Law, and an affiliate of Duke’s Institute for Genome Sciences and Policy. If the court rules against Myriad, “this may make it easier for you to get second opinions,” about diagnostic tests, she said.

Myriad owns the patents to the genetic sequences, as well as any mutations along those genes. The American Civil Liberties Union, which has brought the case on behalf of a coalition of patients, researchers and doctors, argues that that means that if genes from a particular person are analyzed or separated from other biological material, regardless of how or for what reason, that would constitute patent infringement.

The industry has countered for years -- and won on this argument -- that they don't patent the genes, but the man-made molecules based on those genes.

Myriad’s current exclusive right to the testing means all BRCA tests are conducted by Myriad. There’s no second opinion or confirmation by an independent second source and Myriad can set its own price free of competition. 

If the court rules in favor of Myriad, that won’t change. “They have had a monopoly over all genetic testing for breast cancer for nearly two decades,” says bioethicist Arthur Caplan, an NBC News contributor and director of medical ethics at New York University’s Langone Medical Center. “Doctors and patients have complained bitterly that Myriad’s high-priced tests have limited access for many women.” The tests can cost up to $3,500, although a statement on Myriad's website says the company offers a financial assistance program for low-income or uninsured women.

Moreover, since only Myriad can perform the tests, it can, and does, keep any data it gleans from tests results, such as geographic and demographic patterns, or new genetic variants  it may find. It has stopped sharing this data publicly, keeping it as its own trade secret so nobody else can use it to conduct research or develop therapies or tests.

“Now [Myriad] controls this database, including gene variants that may have unknown clinical significance,” says Michael S. Watson, executive director of the American College of Medical Genetics. So even though they don’t have patents on such data, “they control the marketplace.”

Such control could keep costs high for patients and insurers, and strangle competing research. For example, when new BRCA-related variants were uncovered,  Myriad didn’t include them in its standard BRCA testing. Rather, it created a supplemental test, called BART, available at an extra charge of $700, to cover these mutations.  So if a woman wants to cover all the BRCA bases, her doctor would have to order both tests.

The ACLU argues that genes are simply part of nature and therefore not patentable in the first place.

A ruling in favor of Myriad could also hamper the promise of “personalized medicine” based on our individual genetic makeups. Soon, some scientists say, it will be practical for doctors to order the sequence of each person’s genome to look for disease-related gene variations. But if big parts of the genome have been locked under patent protection, what would a doctor be able to do with that information?

Take, for example, the case of muscular dystrophy, a genetic disorder that weakens the body’s muscles. A number of patents related to mutations in the dystrophin gene have been issued. If a parent were to have a young child’s genome sequenced,  the doctor may not able to communicate any important results relating to the dystrophin gene because the right to do that belongs to the companies or individuals who control the intellectual property. The doctor, or the genome sequencing company, could be sued.  

“That has enormous implications for a family,” says Watson. “They could have another child who's affected. Care could be approached differently if they knew they had [genetic] features of muscular dystrophy."

Many academic research scientists say that so-called “gene patents” hamper their ability to share information, slowing the pace of invention for new therapies for dreaded diseases, or making that research too expensive.

“Myriad’s early patent arguably hindered the willingness of others to aggressively explore better tests for a terrible disease,” Caplan said. “Other patents on other gene sequences could have the same effect.”

Anybody trying to develop a drug related to a patented gene sequence would have to deal with the patent holder, adding costs, time, and legal complications, possibly delaying or even preventing innovation.

Supporters of such patenting argue that striking down Myriad’s intellectual property claims could actually hinder the development of life-saving therapies because companies wouldn’t take the financial risk to pursue them. Medical science could stall. A ruling for Myriad by the Supreme Court, could help spark, or at least protect, the innovation engine, ultimately saving patient lives, its backers claim.  

Besides, they say, there is no such thing as a patent on a human gene. No one's patenting nature; they're patenting man-made molecules derived from human genetic information that are used to test for increased risk of breast cancer and ovarian cancer, argued Karen Dow, a San Diego partner in the law firm Sughrue Mion PLLC, who has long experience in the biotechnology industry, but is not involved in the current case.

In the BRCA case, an appeals court has agreed with this argument and upheld the patents.

But major medical societies fear what impact a ruling in favor of Myriad could have.  

“The care available to patients should not be restricted because the naturally occurring building blocks of human biology have been inappropriately patented,” Dr. Jeremy A. Lazarus, president of the American Medical Association, said in a statement to NBC News. “Opportunities for scientific research and medical care based on human genes must remain available to all and exclusive to none.”

Brian Alexander is co-author, with Larry Young, of "The Chemistry Between Us: Love, Sex and the Science of Attraction."

Related stories:

• A search for visionaries to crack human brain's code
• Genetic test catches rare disease faster in newborns

Just in time for Valentine’s Day, researchers from the U.S. Centers for Disease Control and Prevention issued two new studies of sexually transmitted infections (STIs) today detailing what the lead author of one calls “an ongoing, severe, STI epidemic.”

The studies reveal new infection data, some of it available for the first time, for the eight most common STIs -- chlamydia, gonorrhea, syphilis, herpes, human papillomavirus (HPV), hepatitis B, HIV, and trichomoniasis. The studies, which estimate infection rates and medical costs related to STIs, were published in the journal Sexually Transmitted Diseases.

Both are startling. In 2008, there were 20 million new incidents of infection in the United States, and a prevalence (new infections plus ongoing infection) of 110 million, according to CDC estimates. (Because one person may have more than one infection, the 110 million figure does not mean 110 million people have a sexually transmitted disease.) As a result, the United States incurred estimated direct medical costs of nearly $16 billion.

Previous such estimates, for years 1996 and 2000, estimated approximately 15 million and 18.9 million new incidents respectively, though these reports used somewhat different data sources and methodology so the CDC cautions against making direct comparisons. According to the Henry J. Kaiser Family Foundation, the American Social Health Association, and the CDC, the U.S. has the highest rate of STIs in the industrialized world.

“STIs take a big health and economic toll on men and women in the United States, especially our youth,” CDC epidemiologist Catherine Lindsey Satterwhite, who led the study of incidence and prevalence, told NBC News. 

Although people age 15-24 account for only 25 percent of the nation’s sexually experienced population, Satterwhite’s study estimates they account for about half of all sexually transmitted infections.

Because every STI is preventable, Satterwhite argued, “we know that preventing STIs could save the nation billions of dollars each year.”

The story could have been different, insisted Matthew Golden, the director of Public Health Seattle and King County HIV/STD Program and a professor of medicine at the University of Washington Center for AIDS and STD. The good news, he said, is that rates for most viral and bacterial infections, including HIV, have stabilized or even dropped.

The “epidemic” Satterwhite speaks of, he said, is driven almost entirely by two bugs: HPV, and chlamydia. Chlamydia, a bacterial infection, is easily curable if it’s diagnosed. And there’s a very effective vaccine for the most dangerous forms of HPV that can trigger cervical, oral, anal, and penile cancers, and cause genital warts.

But, Golden argued, “we have snatched defeat from the jaws of victory” by not pursuing effective strategies, such as school-based universal access to the HPV vaccine.

Only about 35 percent of American girls age 13-17 had received the complete course of HPV vaccine as of 2011, according to the CDC. The rate among boys was about 28 percent. In comparison, Australia’s National HPV Vaccination Program provides the vaccine to girls at age 12 and 13 through their schools. As a result, 72 percent of girls have received a complete vaccine by age 15. (Boys were added to the program this year.)

Satterwhite’s study estimated 14.1 million new HPV infections during 2008 and a prevalence of 79.1 million, making it the most common STI by far. While the majority of HPV infections are cleared by the body’s immune system, some are not.

“How could we possibly have done this to ourselves?” Golden asked. “We have a solution; we have to make it happen.”     

Chlamydia can go undiagnosed if it doesn’t cause symptoms and since many young people are not routinely screened, cases can go untreated. This can result in pelvic inflammatory disease (PID) infertility, and ectopic pregnancies. A 2004 study from CDC epidemiologists and economists estimated that “costs per case of PID, including those associated with acute PID, chronic pelvic pain, ectopic pregnancy and treated infertility, range from $1,060 to $3,626.” 

Meanwhile, STI prevention and awareness programs targeting other infections are also critical. For example, Satterwhite estimated 820,000 new gonorrhea infections in 2008. While the U.S. has largely escaped it so far, drug-resistant gonorrhea is slowly spreading around the world. Condoms offer protection against gonorrhea, as well as chlamydia, HPV and other STDs, something to consider before that Valentine’s Day date. 

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

Related:

Sex with an -ex common among young adults

Herpes "bottleneck" could lead to new treatment