First published in 1952, the tome also is used as a standard by researchers, the health insurance industry and pharmaceutical companies.
The proposed revisions are "based on the most rigorous and up-to-date scientific findings available," said Dr. Darrel Regier, the DSM-5 task force vice chairman. Inclusion, meanwhile, "means that a mental illness is more likely to be a target of research, which ultimately will improve our understanding how best to diagnose and treat psychiatric disorders," he said.
Critics say some of the new entries broadly extend some definitions of mental illness and lower thresholds for some existing disorders, which will result in higher rates of diagnoses. That, they argue, "could result in massive overtreatment with medications that are unnecessary, expensive and often quite harmful," Dr. Allen Frances, chairman of the DSM,-IV task force, wrote in the Psychiatric Times.
In response, the American Psychiatry Association, which publishes the manual, has increased the transparency of the process; All the proposals can be found at dsm5.org. It has extended the publication date to May 2013.
Today's DSM defines 238 mental illnesses. Among the proposed changes for DSM-5 are a single diagnosis for autism and related disorders, the classification of binge eating as a medical condition, and the inclusion of the category "nonsuicidal self-injury" to distinguish those who cut themselves from those who are attempting suicide. Here's a small sample of some proposed changes:
Autism spectrum disorder
The change: Creates a single diagnosis
Since doctors approach patients on the spectrum in different ways, a child might get three different diagnoses. "Previously, the criteria were equivalent to trying to 'cleave meatloaf at the joints,'" the working group wrote in its rationale for the change. Instead of "autistic disorder," the name would be autism spectrum disorder; it would include autism, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.
The change: Lowers threshold
If you eat a large amount of food at one time, feel like you can't stop and are disgusted, embarrassed or feel depressed by how much you ingested, you meet a few of the criteria for binge-eating disorder.
Included in the appendix of the current DSM, binge eating has been compared with anorexia nervosa, bulimia nervosa and obesity. But due to its distinct characteristics, it would become a free-standing diagnosis.
What concerns some is that bingeing is a fairly common behavior. The diagnosis would apply to those who binge, on average, at least once a week for three months. In the current DSM, the frequency was at least two days a week for six months; the lower threshold could medicalize normal behavior, critics say.
The change: Distinguishes self-harm from suicidal tendencies
People who injure themselves by cutting, burning, stabbing, hitting or excessive rubbing don't necessarily want to die. Cutters, for example, may feel a sense of relief, which is very different from a highly stressed individual who seeks to end his life, said Dr. Mark Olfson, a professor of clinical psychiatry at Columbia who is not involved with the revisions.
"Currently, a person who comes to ER after making a suicide attempt, say by intentionally swallowing pills with the intent to die, is diagnosed with the same disorder as someone who makes a small cut to his or her wrist to relieve anxiety and has no intent to die," said Olfson.