As part of their ongoing review process, the American Psychiatric Association's DSM-5 Task Force will be soliciting public feedback on the draft fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from May 2 through June 15, 2012. This is the final public review period and follows the previous review period of May-June 2011. Already the subject of considerable controversy, the DSM-5 is due for release in May 2013 and is likely to shape mental health policy across North America for years to come. Along with changes to the diagnostic criteria for many established psychiatric disorders, the DSM-5 will also be introducing new diagnosed such as Suicidal Behavior Disorder, Non-Suicidal Self-Injury Disorder, and Persistent Complex Bereavement Disorder. Among the significant changes proposed for existing psychiatric diagnoses, the DSM-5 task force is recommending:
- A redefining of current autism diagnoses into a single diagnosis know as Autism Spectrum Disorder intended to accomodate all of the complex problems faced by children and adults currently diagnosed as autistic. This is meant to include Asperger's Syndrome, childhood disintegrative disorder, and pervasive development disorder- not otherwise specified (PDD-NOS). By combining these different diagnoses into a single diagnostic category into a single diagnostic category, the DSM-5 task force is hoping to eliminate potential confusion given the similar symptoms displayed by individuals with the different diagnoses.
- Redefining Major Depressive Disorder to allow for he often devastating consequences of grief. Since patients dealing with bereavment often mimic some or all of the diagnostic criteria of Major Depression. Due to the possibility of misdiagnosis by untrained people using diagnostic checklists, the new DSM-5 will include footnotes to help clinicians recognize how loss reactions can be distinguished from mental illness.
- Due to c0ncerns about the proposed diagnosis of Attenuated Psychosis Syndrome (which in turn replaces the even more controversial Psychosis Risk Syndrome diagnosis) as well as Mixed Anxiety Depressive Disorder, these two diagnosis have been deferred for further study and possible inclusion in future versions of the DSM.
- Communication disorders have now been expanded to Language Disorder and Speech Disorder. A third diagnosis, Social Communication Disorder is proposed (which is distinguished from Autism Spectrum Disorder).
- Under the general category of Sleep-Wake Disorders (formerly Sleep Disorders in the DSM-IV-TR) are a range of new diagnoses including Insomnia Disorder, Hypersomnolence Disorders, Obstructive Sleep Hypopnea Syndrome, Nightmare Disorder, Restless Legs Syndrome, Rapid Eye Movement Sleep Behavior Disorder and Substance-induced Sleep Disorder.
- Trauma and Stressor-Related Disorders will be placed in a separate category and Posttraumatic Stress Disorder will be given a new subtype for preschool children. This category will also include Acute Stress Disorder, Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, and Trauma- or Stressor-Related Disorders Not Elsewhere Classified.
- The Sexual and Gender Identity Disorders Work Group has proposed a new diagnostic term Gender Dysphoria with subcategories for children, adolescents and adults. The new diagnostic label will replace existing categories of Gender Identity Disorder and Transvestic Fetishism and has already generated enormous opposition by transgender activists.
- Existing DSM-IV-TR diagnoses often linked to antisocial behaviour in children and adults including Conduct Disorder, Oppositional Defiant Disorder and Intermittent Explosive Disorder are now categorized under Disruptive, Impulse Control and Conduct Disorders. Antisocial Personality Disorder (also termed Dyssocial Personality Disorder) is included in this category along with Disruptive Behavior Disorder Not Otherwise Classified.
- The category Substance Use and Addictive Disorder has been expanded to include Gambling Disorder (formerly classified as an Impulse Control Disorder), Tobacco Use Disorder, and Tobacco Withdrawal. A group of diagnoses linked to Unknown Substance Use are also included for the first time. As well, Caffeine Use Disorder, Internet Use Disorder, and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure have been added to Section III of the DSM-5 for further study.
- There is also a radical redefinition of personality disorders proposed for the DSM-5 with a streamlined approach to diagnosis and an extensive guide for implementation. A series of examples will be included to help clinicians make a proper diagnosis.
- Paraphilic Disorders are now listed in a separate category. Pedophilic Disorder has been expanded to include a new Hebephilic subtype to reflect sexual attraction to post-pubescent children. Including hebephilia in the DSM-5 has been extremely controversial with mental health professionals opposing its inclusion on various grounds. The Sexual and Gender Disorders Work Group are also recommending the inclusion of Hypersexual Disorder and Paraphilic Coercive Disorder for inclusion in Section III of the DSM-5 for further study.
The DSM-5 editors stress that the proposed changes are not final and will undergo further revisions before the end of 2012. The DSM-5 website will be soliciting comments from the public until June 15th to allow for sufficient feedback. Anyone with concerns about the current form of the DSM-5 is welcome to provide feedback. Given that the importance of ensuring that the DSM-5 will be as fair and unbiased as possible, the time to act is now.