Shyness, grief and eccentricity could suddenly become mental health disorders if the newest edition of the Diagnostic and Statistical Manual of Mental Disorders goes through as planned. But it won't if more than 11,000 petitioners, most of whom are mental health professionals, have their way.
The DSM, the 900-page "bible" of psychiatric symptoms published by the American Psychiatric Association, has been around since 1952. But the fifth and latest edition, scheduled for publication in May 2013, has come under attack for "medicalizing" behaviors that some people would consider normal. The 11,000 petitioners are challenging proposed changes they say would label millions more Americans as mentally ill.
"Our main concern is that they've introduced some new disorders that have never been in a DSM before that we think are not scientifically based," said David Elkins, president of the American Psychological Association's society for humanistic psychology and chairman of the committee behind the petition. "The problem is that millions of people could be diagnosed with a mental disorder when they don't actually have one."
Among the new additions are "mild neurocognitive disorder," a diagnosis that Elkins said makes a disease out of normal aging, and "disruptive mood disregulation disorder," a diagnosis slapped on kids who sulk and throw temper tantrums. "Internet addiction" would also make its debut as a formal diagnosis.
The diagnoses not only label people exhibiting these behaviors as having mental illness but also qualify them for psychiatric drugs that could produce serious side effects, Elkins said.
"We're not opposed to the proper use of psychiatric drugs when there's a real diagnosis and when a child or an adult needs pharmacological intervention," said Elkins. "But we are concerned about the normal kids and elderly people who are going to be diagnosed with these disorders and treated with psychiatric drugs. We think that's very, very dangerous."
Dr. Allen Frances, professor emeritus of psychiatry at Duke University and chairman of the revisions committee for DSM-4, said the new additions would "radically and recklessly" expand the boundaries of psychiatry.
"They're at the boundary of normality," he said. "And these days, most diagnostic decisions are not made by psychiatrists trained to distinguish between the two. Most are made by primary care doctors who see a patient for about seven minutes and write a prescription."
Under the revisions, Frances said he himself would be diagnosed with mild neurocognitive disorder.
"You don't want to be inventing new diagnoses until you're sure they can be accurately made, effectively treated that the treatments are safe," said Frances. "None of these conditions is fulfilled in DSM-5."
Frances said the vetting process for new diagnoses should be just as stringent as it is for new drugs.
"You can't have one professional organization, like the American Psychiatric Association, responsible for something so important," he said.
In a Jan. 9 letter to the American Psychiatric Association and the DSM-5 Task Force, Elkins and other mental health professionals requested that the revisions be reviewed by an independent group of scientists and scholars with no ties to the association. Elkins said the association said such a review was "impossible."
While the American Psychiatric Association did not comment on the petition specifically, it said in a statement that it does consider "input from all sectors of the mental health community a vital part of the process, and all comments are being reviewed by a task force and work group members. ... We are confident that the DSM-5 will be based on the most reliable scientific and clinical data. …"