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    5
    days
    ago

    Psychiatrists, critics face off over psychiatric manual

    By LINDSEY TANNER , The Associated Press

    CHICAGO -- In the new psychiatric manual of mental disorders, grief soon after a loved one's death can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain "senior moments" are called "mild neurocognitive disorder." 

    Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common human problems into mental illnesses in a trend they say will just make the "pop-a-pill" culture worse.

    Says a former leader of the group: "Normal needs to be saved from powerful forces trying to convince us that we are all sick."

    At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

    The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It's the manual's first major update in nearly 20 years, and a backlash has taken shape in recent weeks:

    • Two new books by mental health experts, "Saving Normal" and "The Book of Woe," say the world's most widely used psychiatric guide has lost credibility. 
    • A British psychologists' group is criticizing the DSM-5, calling for a "paradigm shift" away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide. 
    • Even the head of the U.S. National Institute of Mental Health complained that the book lacks scientific validity. 

    This week, the NIMH director, Dr. Thomas Insel, tried to patch things up as he and the psychiatrists group issued a joint statement saying they have similar goals for improving the diagnosis and treatment of mental illness.

    The manual's release comes at a time of increased scrutiny of health care costs and concern about drug company influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

    "Way too much treatment is given to the normal 'worried well' who are harmed by it; far too little help is available for those who are really ill and desperately need it," Dr. Allen Frances writes in "Saving Normal." He is a retired Duke University professor who headed the psychiatry group's task force that worked on the previous handbook.

    He says the new version adds new diagnoses "that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders."

    Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual - including autism, attention deficit disorder and bipolar disorder - and billions of dollars spent each year on psychiatric drugs.

    The group's 34,000 members are psychiatrists - medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.

    The most contentious changes include:

    • Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one's death. Major depression is typically treated with antidepressants. 
    • Calling frequent, extreme temper tantrums "disruptive mood dysregulation disorder," a new diagnosis. The psychiatric association says the label is meant to apply to youngsters who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness. 
    • Diagnosing mental decline that goes a bit beyond normal aging as "mild neurocognitive disorder." Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize "senior moments." 
    • Calling excessive thoughts or feelings about pain or other discomfort "somatic symptom disorder," something that could affect the healthy as well as cancer patients. Critics say the term turns normal reactions to a disease into mental illness. 
    • Adding binge eating as a new category for overeating that occurs at least once a week for at least three months. It could apply to people who sometimes gulp down a pint of ice cream when they're alone and then feel guilty about it. 
    • Removing Asperger's syndrome as a separate diagnosis and putting it under the umbrella term "autism spectrum disorder." 

    Dr. David Kupfer, chairman of the task force that oversaw the DSM-5, said the changes are based on solid research and will help make sure people get accurate diagnoses and treatment.

    Dr. Jeffrey Lieberman, the psychiatry association's incoming president, said challenging the handbook's credibility "is completely unwarranted." The book establishes diagnoses "so patients can receive the best care," he said, adding that it takes into account the most up-to-date scientific knowledge.

    But Insel, the government mental health agency chief, wrote in a recent blog posting that the guidebook is no better than a dictionary-like list of labels and definitions.

    He told The Associated Press he favors a very different approach to diagnosis that is based more on biological information, similar to how doctors diagnose heart disease or problems with other organs.

    Yet there's scant hard evidence pinpointing what goes wrong in the brain when someone develops mental illness. Insel's agency two years ago began a research project to create a new way to diagnose mental illness, using brain imaging, genetics and other evolving scientific evidence. That project will take years.

    The revisions in the new guide were suggested by work groups the psychiatric association assigned to evaluate different mental illnesses and recent research advances. The association's board of trustees decided in December which recommendations to include.

    Advocacy groups have threatened Occupy-style protests and boycotts at this week's meeting.

    "The psychiatric industry, allied with Big Pharma, have massively misled the public," the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

    The new manual "will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication," says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.

    Committee member Courtney Fitzpatrick, whose 9-year-old son died seven years ago while hospitalized for a blood vessel disease, said she has joined support groups for grieving parents "and by no means are we mentally ill because we are sad about our kids that have died."

    Gary Greenberg, a Connecticut psychotherapist and author of "The Book of Woe," says pharmaceutical industry influence in psychiatry has contributed to turning normal conditions into diseases so that drugs can be prescribed to treat them.

    Many of the 31 task force members involved in developing the revised guidebook have had financial ties to makers of psychiatric drugs, including consulting fees, research grants or stock.

    Group leaders dismiss that criticism and emphasize they agreed not to collect more than $10,000 in industry money in the calendar year preceding publication of the manual.

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  • 1
    Dec
    2012
    9:27pm, EST

    'Asperger's disorder' being dropped from psychiatrists' diagnostic guide

    The American Psychiatric Association announced a  revision to their diagnostic manual after almost two decades of consideration. TODAY contributor Dr. Gail Saltz discusses the changes, which include new guidelines for treating binge eaters and hoarders and the removal of Asperger's as a diagnosis.

    By Lindsey Tanner, The Associated Press

    CHICAGO -- The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

    The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

    Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

    This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."


    Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

    The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

    One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

    And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

    But the revision will not affect their education services, experts say.

    The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

    Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

    "To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

    Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

    People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

    The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

    The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

    The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

    Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

    Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

    One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

    Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

    Other changes include:

    —A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

    —Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

    More from NBCNews.com health:

    Hey, guys, your beer gut could lead to a broken hip

    Grapefruit may turn more drugs deadly, new study warns

    This is your brain on exercise

     

    © 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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