Psychiatry Manual Drafters Back Down on Diagnoses

In a rare step, doctors on a panel revising  psychiatry’s influential diagnostic manual have backed away from two controversial proposals that would have expanded the number of people identified as having  psychotic or depressive disorders. 

The doctors dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems. 

They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would be mistaken for a mental disorder. 

But the panel, appointed by the  American Psychiatric Association to complete the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., did not retreat from another widely criticized proposal, to streamline the definition of  autism. Predictions by some experts that the new definition will sharply reduce the number of people given a diagnosis are off base, panel members said, citing evidence from a newly completed study. 

Both the study and the newly announced reversals are being debated this week at the psychiatric association’s annual meeting in Philadelphia, where dozens of sessions were devoted to the D.S.M., the standard reference for mental disorders, which drives research, treatment and insurance decisions. 

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and the chairman of the task force making revisions, said the changes came in response mainly to field trials — real-world studies testing whether newly proposed diagnoses are reliable from one psychiatrist to the next — and also public commentary. “Our intent for disorders that require more evidence is that they be studied further, and that people work with the criteria” and refine them, Dr. Kupfer said. 

The psychiatric association has posted its proposals online, inviting public reaction. More than 10,500 comments have come through the site, many of them critical. 

Tags: DSM, autism, depression, disorders, psychiatry, psychotic

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Comment by Logos Tartaros on May 10, 2012 at 7:16am: As I deal with my own personal take on what Shamanism is I'm always drawn to the quote below when ever I read articles like the one above...

The writer who approaches shamanism as a psychologist will be led to regard it as primarily the manifestation of a psyche in crisis or even in retrogression; he will not fail to compare it with certain aberrant psychic behavior patterns or to class it among mental diseases of the hysteroid or epileptoid type.

We shall explain why we consider it inacceptable to assimilate shamanism to any type of mental disease. But one point remains (and it is an important one), to which the psychologist will always be justified in drawing attention: like any other religious vocation, the shamanic vocation is manifested by crisis, a temporary derangement of the future shaman's spiritual equilibrium. All the observations and analyses that have been made on this point are particularly valuable. They show us, in actual process as it were, the repercussions, within the psyche, of what we have called the "dialectic of the hierophanies" - the radical separation between profane and sacred and the resulting splitting of the world. To say this is to indicate all the importance that we attribute to such studies in religious psychology.

- Eliade, Mircea (1972 - First Princeton English Edition). Shamanism: Archaic Techniques of Ecstasy (Foreword Pages 1-2). Princeton University Press: Princeton Oxford)

Comment by My Road on May 10, 2012 at 9:54am: Since under the current definition many doctors already fall prey in diagnosis and/or treatment to this quote: "the normal sadness people experience after the loss of a loved one, a job or a marriage would be mistaken for a mental disorder", whether due to insurance pressures for lack of time, other health system pressures, and aggressive pharmaceutical advertising, I'm glad to see they aren't broadening the breadth of that criteria. Having a relative with autism, my concern about there narrowing is that people who need support will lose the support they'be already had to fight for.

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Psychiatry Manual Drafters Back Down on Diagnoses

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