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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.
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.
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Those who commit mass murders are often angry and isolated, but usually aren't mentally ill, violence experts said Friday after a shooting during the midnight screening of "The Dark Knight Rises" in an Aurora, Colo., movie theater. James Holmes was arrested as a suspect in the shooting that killed 12 people and wounded 59 others.
“It takes a certain degree of clear-headedness to plan and execute a crime like this,” said James Alan Fox, a criminal justice professor at Northeastern University in Boston, who has written several books on mass murder and school violence.
There are exceptions – Jared Loughner, who shot and killed six people in Arizona in 2011, gravely injuring then-member of Congress Gabrielle Giffords, was diagnosed with schizophrenia. Mental health experts say people with mental illness are not any more likely than anyone else to become violent, however.
Mass murderers “often times feel that they are right and everybody else is wrong,” Fox said in a telephone interview. “They really tend to externalize blame, to see other people as responsible for their problems."
They are often socially isolated. “They tend to be a failure at life,” Fox added.
Such well-planned attacks are rare and not meant to make a statement, Fox said. “They basically want revenge,” he said. “Contrary to the common misperception that these guys suddenly snap and go berserk, these are well-planned executions.”
The film the victims were watching is loaded with violence but it’s unlikely that actually inspired the attacker, Fox said. The film was opening that night and it’s doubtful the attacker was familiar with the script.
“It was just coincidental, although it just made the situation more ambiguous for the people involved,” he said. Some of those who were in the theater said they initially first thought the shooting was part of the screening.
Early reports suggest Holmes did not have a police record and the University of Colorado has confirmed he was in the process of dropping out of a Ph.D. program in neuroscience there.
Former FBI profiler Clint van Zandt told TODAY that Holmes was almost certainly acting alone. “Today, so far, he appears to be … the lone wolf,” Van Zandt said. The attack was carefully planned, both Van Zandt and Fox said, which fits the patterns of such attackers.
“They typically plan carefully how they are going to do it, where they are going to do it, what they are going to bring and what they are going to wear,” Fox said. In this case, the victims were not deliberately chosen, although the place, a packed movie theater, probably was.
The attack may encourage copycat actions but not necessarily, Fox said. “What bothers me in situations like this is to see lists of the worst mass shootings,” he said. “It encourages people to try to break records.”
Dr. Victor Schwartz, medical director of the Jed Foundation, which works to promote mental health among college students, agreed. “The media needs to be really careful in these situations,” he said. “On the one hand, you need to report the story. On the other hand, there is the danger of sensationalizing it, almost romanticizing the drama here.”
Schwartz also advises resisting any attempts to speculate on whether violent videos or movies may have affected Holmes. “The research slants both ways,” he said. Some studies suggest that children who watch and play violent videos may become desensitized to some aspects of violence, but there is not a clear consensus.
“None of these things is caused by a single factor,” Schwartz said. “Obviously, these are always very complicated events. The impulse is to find a simple explanation for complicated situations. It is important to resist it.”
Experts say it’s almost impossible to predict attacks like this one. “Neighbors will come forward and say it was no surprise,” Fox said. “But it’s all after the fact. Beforehand, even though someone may fit a profile, we can’t predict they will do this sort of crime. It’s a very rare event and not predictable. That’s part of what makes it so scary.”
Former FBI profiler Clint Van Zandt speaks with TODAY's Matt Lauer again, calling the Colorado movie theater shooter a "lone wolf," which he says is "the thing the FBI director and others are most worried about."
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A simple blood test may one day be all that’s needed to help parents figure out whether a child is suffering from clinical depression or normal teenage angst, a new study suggests.
In a pilot study of 28 adolescents, scientists showed that teenage depression could be diagnosed through a panel of 11 genetic markers, according to a report published in the journal Translational Psychiatry.
If the results are confirmed in larger trials, doctors may one day be able to screen for depression just as they do for diabetes, says study co-author Eva Redei, the David Lawrence Stein professor of psychiatric diseases affecting children and adolescents at Northwestern University's Feinberg School of Medicine.
This new research could help not only teens, but also adults suffering from depression, says Dr. Michael Thase, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania.
“This is very interesting early research that could point to the development of not just biomarkers, but also help with the identification of new genes that are involved with the expression of this common illness,” he says. “And that could potentially lead to new treatments.”
With no actual test, diagnosis of depression is currently subjective and depends on a person's ability to identify and describe symptoms. This is especially difficult for teens who may be particularly out of touch with what's going on.
Researchers developed their test by first studying rats specially bred to model human depression. While rats don’t experience all the symptoms of depression, they do show many of the same signs.
“They huddle together,” says Redei. “They don’t move around a lot. They aren’t much interested in playing. They’re less interested in food than normal rats. And they don’t sleep well.”
Intriguingly, the "depressed" rats also respond well to certain antidepressants, says Redei.
"In reality, depression affects our ancient brains as much as our new brain,” she says. “And the ancient brain is the same in humans as it is in rats.”
Severe depression is thought to be caused by a combination of environmental and complicated genetic factors, she explains, and given the right genetics, can be kicked off by “any kind of environmental challenge such as trauma or life stresses."
To see how the depressive brain reacts to environmental triggers, Redei and her colleagues looked at differences in the way normal rats and depression-model rats behaved in response to stress. They pulled blood samples from all the rats and found a host of markers that differed between the two groups.
In the second part of their study, the researchers examined blood from 14 depressed and 14 healthy teens, looking at the levels of 26 markers that had been identified in the depression-model rats.
They found that 11 of those markers, taken together, accurately predicted which teens were clinically depressed.
Thase, of the University of Pennsylvania, says further research might be a boon to diagnosing both teen -- and adult -- depression.
"Now you would want to see if they get the same results with older people," he says. "Or does it have something to do specifically with early onset depression?"
TODAY's Ann Curry talks with author Lisa Earle McLeod and psychiatrist Dr. Janet Taylor about a new study that claims "supermoms," women who set the unattainable goal of being perfect, are more likely to suffer from depression. NBC's Kate Snow reports.