Changes proposed in how psychiatrists diagnose

WASHINGTON — Don't say "mental retardation" — the new term is "intellectual disability." No more diagnoses of Asperger's syndrome — call it a mild version of autism instead. And while "behavioral addictions" will be new to doctors' dictionaries, "Internet addiction" didn't make the cut.

The American Psychiatric Association is proposing major changes today to its diagnostic bible, the manual that doctors, insurers and scientists use in deciding what's officially a mental disorder and what symptoms to treat. In a new twist, it is seeking feedback via the Internet from both psychiatrists and the public about whether the changes would be helpful.

The manual suggests some new diagnoses. Gambling so far is the lone identified behavioral addiction, but the new category of learning disabilities included problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don't purge.

Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders — such as dementia or schizophrenia — based on early symptoms, even though there's no way to know who will worsen into full-blown illness.

It's a category the psychiatrist group's own leaders say must be used with caution, as scientists don't yet have treatments to lower that risk but also don't want to miss people on the cusp of needing care.

Another change: The draft sets scales to estimate adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

But overall, the manual's biggest changes eliminate diagnoses it contends are essentially subtypes of broader illnesses — and urge doctors to concentrate more on the severity of their patients' symptoms. Thus the draft sets "autism spectrum disorders" as the diagnosis that encompasses a full range of autistic brain conditions — from mild social impairment to more severe autism's lack of eye contact, repetitive behavior and poor communication — instead of differentiating between the terms autism, Asperger's or "pervasive developmental disorder" as doctors do today.

Psychiatry has been accused of overdiagnosis in recent years as prescriptions for antidepressants, stimulants and other medications have soared. So the update of this manual — called the Diagnostic and Statistical Manual of Mental Disorders — has been anxiously awaited. It's the first update since 1994, and brain research during that time period has soared.

The draft manual, to be posted at www.DSM5.org, is up for public debate through April.

Fast facts

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Los Angeles Times

Changes proposed in how psychiatrists diagnose 02/09/10 [Last modified: Tuesday, February 9, 2010 10:39pm]

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