Doctors Propose Changes to the 'Bible of Psychiatry'

Feb 10, 2010 — -- What's in a label?

Are you "clinically depressed" or just sad? Is your child having a temper tantrum or showing signs of a disorder?

What about when we dig into some major comfort food or go on a big shopping spree? Is that kind of behavior just some self indulgence or is it actually self destructive?

These are the kinds of questions facing doctors charged with trying to draw the line for the new version of the Diagnostic and Statistical Manual of Mental Disorders, the so-called "Bible of Psychiatry."

This will be the book's fifth edition and doctors are proposing to re-name and re-categorize dozens of behaviors.

New Labels and Big Changes

The changes have the power to affect the way millions of people are treated and how much, if any, coverage insurance companies provide for those treatments. So not surprisingly, everyone is talking about it.

"It's a mixed reaction among the medical community," said Dr. Max Wiznitzer, a pediatric neurologist with the Rainbow Babies & Children's Hospital, "What it will provide is a more homogeneous grouping so we don't have confusion about individuals [and] what we call them."

One of the biggest changes proposed involves eliminating the Asperger's diagnosis as well as a number of other childhood developmental disorders and instead folding them into a new category called "Autism Spectrum Disorders."

But while some people with Asperger's say lumping them in with autism is unfair, many doctors argued it's a good thing.

"The use of single term will actually simplify care, simplify service delivery, [and] simplify issues with insurance," said Wiznitzer, "In some states, for instance, a label of Asperger's syndrome does not get you educational services but a label of 'autism spectrum' does."

Another proposed change involves adding a new childhood disorder called "Temper Dysregulation with Dysphoria," which is defined as children who have persistent bad moods with bursts of rage.

Bad moods and bursts of rage? Some might say that sounds an awful lot like most children.

New Drugs and New Insurance?

But Dr. Michael First, a professor of clinical psychiatry at Columbia University, said the new label is actually meant to stop doctors from mis-diagnosing kids who have bad tempers with the more serious bipolar disorder.

Then, there's the newly-created "Mixed Anxiety Depressive," defined as exhibiting depressive symptoms for just two weeks.

The next logical question, of course, is whether the new labels mean new drugs.

"Clearly, doctors will be very tempted to try out anti-depressants on this, and you know there's a huge potential for people getting medication being pressured to get medication for normal sadness," First said.

A new "Behavioral Addiction" category would also be created that included "Gambling Addiction." But you won't find "Sex Addiction" or "Internet Addiction" there. The authors have agreed that more research needs to be done before they can recognize those terms as a true "addiction."

That exclusion means insurance companies may no longer cover treatment for those "addictions." But it probably won't stop hundreds of people from evoking them as an excuse anyway.

The DSM's Web site has the proposed draft revisions. Officials there want to know what you think. Sign up and let them know your opinion of the potential changes.