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Updating mental illness diagnosis

Frances, who served as chairman of the DSM-IV task force, is widely recognized as the most outspoken critic of the APA's latest revisions.

Like Shorter, he believes that the DSM-5 was largely based on unsound science and academic politics, and has taken issue with the strict confidentiality under which the proceedings unfolded.

The book has undergone four major revisions since first being published in 1952, with each one drawing varying degrees of criticism.

The book's forthcoming fifth edition, known as DSM-5 and due to be published in May, has sparked a particularly fierce debate, prompting accusations of bias and recklessness on the part of the APA, and even eliciting calls for a boycott.

Initially conceived as a reference book to standardize the terminology of known mental illnesses, the document eventually morphed into a more formalized diagnostic guide, beginning with the DSM-III in 1980. David Kupfer, a professor of neuroscience at the University of Pittsburgh School of Medicine and co-chair of the 31-member DSM-5 task force, says that the book provides professionals around the world with a common language, describing it as an "invaluable tool." He insists that the book remains an "evidence-based manual," noting that the task force published its proposed changes for professional and public review on two occasions before finalizing this latest edition. Edward Shorter, a social historian of medicine at the University of Toronto, says that DSM deliberations have historically been more about "horse trading" in the name of consensus rather than scientific analysis.

"They don't just look a diagnosis up in a book and then apply the criteria without any subjectivity. Peter Dozier, a pediatric psychiatrist at the Children's Hospital of the King's Daughters in Norfolk, Virginia, says he consults the DSM at least "several times a week," but only to look up the diagnostic codes required for medical billing and insurance forms.

One of the most contentious is a new disorder called "Disruptive Mood Dysregulation Disorder"(DMDD) — a diagnosis for children aged 6 to 18 who exhibit "temper outbursts that are grossly out of proportion in intensity or duration to the situation." The idea is to stem the misdiagnosis of child bipolar disorder — a condition of dubious scientific merit — though some say that its broad language could incorrectly label youthful temper tantrums as symptomatic of a deeper problem.

Another proposal calls for the removal of the "bereavement exclusion" — a provision in the DSM-IV that drew a distinction between depression and grief following the death of a loved one.

Among the book's most controversial revisions are proposals to broaden the definition of depression, and to categorize childhood tantrums as a bona fide disorder.

Each revision to the DSM is determined by a task force of doctors and researchers.


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