On Saturday, revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM) were approved by the Arlington-based American Psychiatric Association’s board of trustees, including the elimination of the term “Asperger’s disorder” and “mental retardation.”
The DSM had its last major revision almost two decades ago, in 1994. With the wealth of new scientific evidence on various mental illnesses and epidemiology, it was due time and necessary for the American Psychiatric Association to revise its current diagnostic system, APA president Dr. Dilip Jeste wrote in a statement.
We spoke with APA chair Dr. David Kupfer, one of the major leaders of the task force group, to get more information about the DSM-5 revisions and what they mean for clinicians and patients.
1) The term “Asperger’s disorder” is being dropped.
A main concern among parents with children diagnosed with Asperger’s disorder was the proposal to drop the term from the manual. While it has been eliminated, it will be incorporated under the new umbrella term “autism spectrum disorder,” says Kupfer. “We decided to place autistic disorder, Asperger’s, childhood integrative disorder, and pervasive mental development disorders under one umbrella of diagnoses to allow clinicians to make more precise set of decisions and assessments about the children.”
2) “Mental retardation” is being changed to “intellectual developmental disorder.”
It’s no longer politically correct to say one suffers from “mental retardation.” The new term, intellectual developmental disorder, has long been used by the World Health Organization's International Classification of Disorders. “We felt it was important to be aligned with what’s going on with the rest of the world,” says Kupfer. “We wanted to have this manual as harmonized with them as possible.”
3) There’s a bigger focus on post-traumatic stress disorder (PTSD).
“We paid much more attention to post-traumatic stress disorder with what’s been going on with the armed forces,” says Kupfer. That includes information on diagnoses and treatment for PTSD from sports injuries, as well.
4) Eating disorders are more defined.
“Eating disorders affect people across the whole lifespan,” says Kupfer. But the task force group felt that there were children and adolescents being diagnosed with eating disorders not otherwise specified 50 percent of the time, he adds. New guidelines include more precise diagnoses criteria. Binge-eating disorder has become a main category section, for example.
5) The manual will be approximately 800 to 1,000 pages.
The DSM-5 may be hefty, but for the first time next year, an electronic version will be available, including videos of assessments on patients, references, and more. “It’s very important to make sure patients and families really understand what’s going on,” says Kupfer. “So in many ways we’re trying to put things together that make it more user-friendly.”
6) It may be a couple more decades until the next major revision.
While it will likely be some time before we can expect a DSM-6, it may only be a few years until a DSM-5.1 or -5.2, thanks to the expected digital version of the manual. “We don’t wait to wait another 19 to 20 years to have a new revision of the whole volume,” says Kupfer. “But if there is some unexpected consequence, which we can’t anticipate, we have an opportunity to fix something two to three years from now.”
For more information on the DSM-5 revisions, visit DSM5.org.