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                 Revision of Mental Illness Guide Stirs Debate

   by Jessica Berman

   A long-anticipated revision of an official diagnostic guide to mental
   illness, known as the DSM-5, was released this week.  While the new
   manual is being welcomed by some doctors as reflecting advancements in
   the understanding and diagnosis of mental disorders, critics say its
   definitions of psychiatric conditions are based too much on symptoms
   and too little on the biological causes of mental illness. VOA's
   Jessica Berman has more on the controversy.
   The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is
   considered by many psychiatrists and psychologists to be the "bible" by
   which they can diagnose and treat their patients' mental illnesses.

   It's been nearly 20 years since the DSM's publisher, the American
   Psychiatric Association, or APA, did a major revision of the voluminous
   guide.
   David Kupfer, a professor of psychiatry at the University of Pittsburgh
   in Pennsylvania, headed the international task force that put together
   this fifth version of the DSM.  Kupfer says it was time to update the
   manual, a process that took the task force a decade to complete.
   "We are quite excited about putting out DSM-5 as a revision due to the
   fact that many things have happened over the last 19 years; that it was
   felt, in terms of scientific evidence that we were ready for a change,"
   Kupfer said.
   For example, the manual drops the separate diagnosis of Asperger's
   syndrome, a developmental disorder marked by significant difficulties
   with social interaction, and folds it into a broader category called
   autism spectrum disorders.

   Asperger's is considered the mildest form of autism, which can cause an
   inability to communicate with others, emotional outbursts and
   repetitive behaviors.
   Kupfer believes that the change in the Asperger's designation is
   relatively minor. But Alycia Halladay, a senior director of Autism
   Speaks, an advocacy group for people with autism, thinks otherwise.
   Halladay says people who were previously diagnosed with Asperger's will
   still have access to special treatment and training programs in the
   U.S,  But she says it will be harder to get approval for treatment for
   people newly diagnosed with Asperger's.
   "We're concerned about individuals who may have shown symptoms of
   Asperger's or may show symptoms of what was called Asperger's not
   meeting the criteria for what is now called autism. And therefore not
   receiving services," Halladay said.
   Another significant change in DSM-5 that critics have targeted is its
   revised definition of depression.  The old criteria were that a patient
   had to display symptoms of unhappiness or lack of pleasure for weeks or
   months at a time.
   Now, the manual specifies that a psychiatrist may diagnose a patient
   with clinical depression after just two weeks of persistent sadness.
   "Diagnose((ing)) major depression after a bereavement is medicalizing
   a normal human reaction, that is the grief of losing ((a)) loved one,"
   Cuthbert said.
   Bruce Cuthbert is coordinator of the US National Institute of Mental
   Health's Research Domain Criteria Project or RDoC.  RDoC is tasked with
   pulling together the latest research identifying the biological
   underpinnings of mental disorders such as depression and schizophrenia.
   Cuthbert says the DSM-5 continues the prevailing symptoms-based
   approach to the diagnosis and treatment of patients with psychiatric
   disorders.  It's an approach he calls "hit or miss" since the drugs and
   therapies prescribed to relieve a mental health condition don't always
   work as hoped.  As a result, Cuthbert says, doctors frequently resort
   to trying different medications on the same patient.
   Cuthbert says mental health research also tends to follow definitions
   outlined in the DSM manual.
   "That's what we need to change, because we know that these categories
   are very complicated.  There are many different mechanisms of brain
   functioning and behavior that are involved with any one of these
   disorders," Cuthbert said.
   As scientific research sheds new light on the biological causes of
   mental illness, Cuthbert says doctors will be able to target
   increasingly effective treatments for their patients' psychiatric
   disorders.  Experts say those advances will be incorporated by the
   American Psychiatric Association in future revisions to its DSM.
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   [1]http://www.voanews.com/content/medical-diagnosis-depression-mental-i
   llness/1666567.html

References

   1. http://www.voanews.com/content/medical-diagnosis-depression-mental-illness/1666567.html