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After years of research, debate, and revision, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is hitting the shelves.
The release of the DSM-5 marks the first time the influential diagnostic manual has been updated in nearly 20 years. The goal in putting together the fifth edition was not to do anything radical, said Dr. Dilip V. Jeste, president of the American Psychiatric Association, but to bring the science up to date and to make it more user friendly for clinicians.
"The goal is to make sure that we have more accurate diagnoses so we can get better mental health services and improve patient outcomes," Dr. Jeste said.
The DSM-5 moves from a multiaxial system to a single axis format. It didn’t make sense to separate the disorders in that way, Dr. Jeste said, and the change makes it simpler for psychiatrists to use. The DSM-5 also puts a greater focus on the roles of age, gender, and culture. Every chapter will include a section on how to apply these factors when making a diagnosis.
Overall, the DSM-5 is not significantly different from the DSM-IV, said Dr. Joel Paris, a professor of psychiatry at McGill University, Montreal, and author of the "The Intelligent Clinician’s Guide to the DSM-5" (New York: Oxford University Press, 2013). Psychiatrists do not need to worry that they will be dealing with a completely new manual, he said, because most of the controversial changes were not accepted in the final version of the manual.
Dr. Paris, who was not involved in the DSM revision, said some those big changes were rejected by the DSM-5’s Scientific Review Committee because they did not have enough scientific data to back them up. "We’re just starting the science of psychiatry," he said. "It’s early days."
But there are some notable changes in the new manual. Experts who worked on the DSM-5 highlighted some of the revisions most likely to affect the way in which how psychiatrists practice.
Mild neurocognitive disorder
In the DSM-5, neurocognitive disorders are divided into two subtypes: mild and major. Major neurocognitive disorder lines up with the DSM-IV definition of dementia. But the DSM-5 Neurocognitive Disorders Work Group created a new subtype to describe mild neurocognitive decline that is more severe than the normal forgetfulness of aging but doesn’t rise to the level of dementia.
The DSM-5 includes specific criteria to help make the diagnosis of mild neurocognitive disorder, said Dr. Dan G. Blazer, cochair of the Neurocognitive Disorders Work Group and a professor of psychiatry and behavioral sciences at Duke University in Durham, N.C.
A patient with mild neurocognitive disorder is likely to complain of memory problems but will not have significant cognitive problems and would not meet the criteria for major neurocognitive disorder. Such patients often are able to complete their daily tasks, but it takes significantly more time and effort. For instance, a patient with mild neurocognitive disorder might take 2 hours to balance a checkbook, when it took just 10 minutes in the past.
Patients with mild neurocognitive disorder should fall somewhere between 1-2 standard deviations below normal on neuropsychological tests, Dr. Blazer said. While the DSM-5 does not recommend a specific test, Dr. Blazer said using some type of standardized test is important. "As we move along in this field, it’s going to be very important to objectively document the level of cognitive impairment that individuals have," Dr. Blazer said.
One of the challenges with this diagnosis is the question of whether these patients will progress and develop dementia. The answer is not necessarily, Dr. Blazer said. While this group has a higher likelihood of progressing to more severe problems, it is not a diagnosis of "pre-dementia," he said.
For many psychiatrists, the biggest change will be to begin asking patients about their level of functioning when they come in with memory complaints. That’s something that can be easily overlooked in a busy practice, Dr. Blazer said.
Major neurocognitive disorder
Previously memory impairment was essential to making a diagnosis of dementia, now called major neurocognitive disorder. But the DSM-5 no longer requires memory impairment to be present, said Dr. Jeste, who served on the Neurocognitive Disorders Work Group and is a professor of psychiatry and neurosciences at the University of California, San Diego.
The change was made to acknowledge that there are major neurocognitive disorders in which memory impairment is not present until late in the course of the illness. For instance, with frontotemporal dementia, which can occur when the patient is aged 50 years, memory impairment does not become apparent until much later in life. Instead, the main symptom is a change in personality. The change will likely reduce the number of patients who receive a "not otherwise specified" (NOS) diagnosis, Dr. Jeste said.
Intellectual disabilities
The DSM-5 removes the term "mental retardation" in favor of a diagnosis of intellectual disability. But the revisions go beyond the name change, according to Dr. Susan E. Swedo, who chaired the Neurodevelopmental Disorders Work Group for DSM-5.
The new definition is based not only on cognitive capacity, but also on adaptive functioning. The DSM-IV included four diagnostic codes for mental retardation: mild, moderate, severe, and profound. But the DSM-5 has only a single diagnosis of intellectual disability. The manual includes specifiers to use when grading the severity level. The specifiers also are based on both cognitive capacity and adaptive functioning.
Dr. Swedo predicted that because the new criteria are "real-world based," it will make it easier for primary care physicians to make a tentative diagnosis.
Autism spectrum disorder
The APA got a lot of attention when it announced plans to combine autistic disorder, Asperger’s disorder, and pervasive developmental disorder NOS into single spectrum called autism spectrum disorder (ASD). But the big change for psychiatrists will be the new criteria for assessing the severity of ASD.
The DSM-5 does not have an overall severity score for autism. Instead of mild, moderate, and severe, ASD is defined in terms of the level of support required. "We had grave concerns that if somebody got a mild autism diagnosis that it would deny [the patient] services," Dr. Swedo said. "If you meet threshold criteria for autism, you have an impairing condition and deserve help."
The DSM-5 also includes a specifier for when ASD is associated with a known medical or genetic condition or an environmental factor. This new specifier was included to encourage clinicians to include information about potential etiologic associations such as Fragile X syndrome, fetal alcohol exposure, and epilepsy.
The DSM-5 also includes a new diagnostic category outside of ASD called social communication disorder. The diagnosis is likely to be a good fit for children with severe attention-deficit/hyperactivity disorder (ADHD) and social skills deficits, Dr. Swedo said. One of the criteria for the disorder is that ASD must be ruled out.
Dr. Swedo said she does not expect psychiatrists to experience any confusion about which patients should receive a diagnosis of social communication disorder vs. ASD. During the pediatric field trials for the DSM-5, physicians moved very few children and adolescents with a pervasive developmental disorder (not otherwise specified) diagnosis into the social communication disorder category. Instead, they pick up a significant fraction of new patients, she said.
Somatic symptom disorders
The DSM-5 revamps the diagnostic criteria for somatic symptom disorders, bringing many different somatic conditions into a new disorder known as somatic symptom disorder. In previous versions of the DSM, the different diagnoses had overlapping boundaries, and the criteria ranged from too stringent to too loose, said Dr. Joel E. Dimsdale, chair of the Somatic Symptoms Work Group and professor emeritus of psychiatry at the University of California, San Diego. The result is that physicians felt uncomfortable using the somatoform diagnoses, and patients often went unrecognized and untreated, he said.
Another problem with the old versions of the DSM is that the focus for these conditions was on medically unexplained symptoms, Dr. Dimsdale said.
"It’s not a reliable distinction that clinicians agree about," he said. "It tends to foster an antagonism between the doctor and patient, and furthermore, it really encourages a mind-body split or dualism."
In the DSM-5, the new disorder known as somatic symptom disorder does not make medically unexplained symptoms central to the diagnosis. The major criteria for somatic symptom disorder are persistent (lasting 6 months or more), significant somatic symptoms that are associated with disproportionate thoughts, feelings, and behaviors, such as extreme levels of anxiety.
"I think doctors will have more confidence when they make that diagnosis," Dr. Dimsdale said.
And the new approach will be less alienating to patients, he said. "You will no longer be suggesting to a patient that his or her medical problems are imaginary, and that’s a significant improvement."
Commentary – Independent research review needed for DSM 5.1
Future editions of the DSM need to consider how outside social and economic forces are influencing mental health diagnosis, according to a commentary published in Health Affairs.
In the article, published on April 24, a group of experts in psychiatry, epidemiology, and social science called for the creation of an independent research review body to examine the scientific evidence on how institutional, social, and cultural factors contribute to variations in psychiatric diagnosis (doi:10.1377/hlthaff.2011.0596).
The experts assembled to revise the DSM have the necessary clinical expertise, but another group is needed to look at societal factors, such as how direct-to-consumer pharmaceutical advertising can affect the spikes in diagnoses or how insurance reimbursement rates can incentivize the diagnosis of more serious conditions, they wrote. The proposed research group also could look at the impact of environmental factors, such as the stress of living during a time of war.
"Research along these lines can clarify whether differences in disease diagnosis across groups results from diagnostic criteria, the way the criteria are applied, or environmental factors that influence people’s susceptibility to disorders," wrote the experts, led by Dr. Helena B. Hansen of the departments of psychiatry and anthropology at New York University.
The independent review body would consider differences in rates of diagnoses by sex, ethnicity, income, or geographic area, as well as rapid increase in a specific diagnosis. The review body also would be tasked with recommending changes to the DSM when its diagnostic criteria led to under- or overdiagnosis of a disorder.
The authors of the commentary received financial support from the Robert Wood Johnson Foundation Health and Society Scholars Program.
On Twitter @MaryEllenNY
After years of research, debate, and revision, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is hitting the shelves.
The release of the DSM-5 marks the first time the influential diagnostic manual has been updated in nearly 20 years. The goal in putting together the fifth edition was not to do anything radical, said Dr. Dilip V. Jeste, president of the American Psychiatric Association, but to bring the science up to date and to make it more user friendly for clinicians.
"The goal is to make sure that we have more accurate diagnoses so we can get better mental health services and improve patient outcomes," Dr. Jeste said.
The DSM-5 moves from a multiaxial system to a single axis format. It didn’t make sense to separate the disorders in that way, Dr. Jeste said, and the change makes it simpler for psychiatrists to use. The DSM-5 also puts a greater focus on the roles of age, gender, and culture. Every chapter will include a section on how to apply these factors when making a diagnosis.
Overall, the DSM-5 is not significantly different from the DSM-IV, said Dr. Joel Paris, a professor of psychiatry at McGill University, Montreal, and author of the "The Intelligent Clinician’s Guide to the DSM-5" (New York: Oxford University Press, 2013). Psychiatrists do not need to worry that they will be dealing with a completely new manual, he said, because most of the controversial changes were not accepted in the final version of the manual.
Dr. Paris, who was not involved in the DSM revision, said some those big changes were rejected by the DSM-5’s Scientific Review Committee because they did not have enough scientific data to back them up. "We’re just starting the science of psychiatry," he said. "It’s early days."
But there are some notable changes in the new manual. Experts who worked on the DSM-5 highlighted some of the revisions most likely to affect the way in which how psychiatrists practice.
Mild neurocognitive disorder
In the DSM-5, neurocognitive disorders are divided into two subtypes: mild and major. Major neurocognitive disorder lines up with the DSM-IV definition of dementia. But the DSM-5 Neurocognitive Disorders Work Group created a new subtype to describe mild neurocognitive decline that is more severe than the normal forgetfulness of aging but doesn’t rise to the level of dementia.
The DSM-5 includes specific criteria to help make the diagnosis of mild neurocognitive disorder, said Dr. Dan G. Blazer, cochair of the Neurocognitive Disorders Work Group and a professor of psychiatry and behavioral sciences at Duke University in Durham, N.C.
A patient with mild neurocognitive disorder is likely to complain of memory problems but will not have significant cognitive problems and would not meet the criteria for major neurocognitive disorder. Such patients often are able to complete their daily tasks, but it takes significantly more time and effort. For instance, a patient with mild neurocognitive disorder might take 2 hours to balance a checkbook, when it took just 10 minutes in the past.
Patients with mild neurocognitive disorder should fall somewhere between 1-2 standard deviations below normal on neuropsychological tests, Dr. Blazer said. While the DSM-5 does not recommend a specific test, Dr. Blazer said using some type of standardized test is important. "As we move along in this field, it’s going to be very important to objectively document the level of cognitive impairment that individuals have," Dr. Blazer said.
One of the challenges with this diagnosis is the question of whether these patients will progress and develop dementia. The answer is not necessarily, Dr. Blazer said. While this group has a higher likelihood of progressing to more severe problems, it is not a diagnosis of "pre-dementia," he said.
For many psychiatrists, the biggest change will be to begin asking patients about their level of functioning when they come in with memory complaints. That’s something that can be easily overlooked in a busy practice, Dr. Blazer said.
Major neurocognitive disorder
Previously memory impairment was essential to making a diagnosis of dementia, now called major neurocognitive disorder. But the DSM-5 no longer requires memory impairment to be present, said Dr. Jeste, who served on the Neurocognitive Disorders Work Group and is a professor of psychiatry and neurosciences at the University of California, San Diego.
The change was made to acknowledge that there are major neurocognitive disorders in which memory impairment is not present until late in the course of the illness. For instance, with frontotemporal dementia, which can occur when the patient is aged 50 years, memory impairment does not become apparent until much later in life. Instead, the main symptom is a change in personality. The change will likely reduce the number of patients who receive a "not otherwise specified" (NOS) diagnosis, Dr. Jeste said.
Intellectual disabilities
The DSM-5 removes the term "mental retardation" in favor of a diagnosis of intellectual disability. But the revisions go beyond the name change, according to Dr. Susan E. Swedo, who chaired the Neurodevelopmental Disorders Work Group for DSM-5.
The new definition is based not only on cognitive capacity, but also on adaptive functioning. The DSM-IV included four diagnostic codes for mental retardation: mild, moderate, severe, and profound. But the DSM-5 has only a single diagnosis of intellectual disability. The manual includes specifiers to use when grading the severity level. The specifiers also are based on both cognitive capacity and adaptive functioning.
Dr. Swedo predicted that because the new criteria are "real-world based," it will make it easier for primary care physicians to make a tentative diagnosis.
Autism spectrum disorder
The APA got a lot of attention when it announced plans to combine autistic disorder, Asperger’s disorder, and pervasive developmental disorder NOS into single spectrum called autism spectrum disorder (ASD). But the big change for psychiatrists will be the new criteria for assessing the severity of ASD.
The DSM-5 does not have an overall severity score for autism. Instead of mild, moderate, and severe, ASD is defined in terms of the level of support required. "We had grave concerns that if somebody got a mild autism diagnosis that it would deny [the patient] services," Dr. Swedo said. "If you meet threshold criteria for autism, you have an impairing condition and deserve help."
The DSM-5 also includes a specifier for when ASD is associated with a known medical or genetic condition or an environmental factor. This new specifier was included to encourage clinicians to include information about potential etiologic associations such as Fragile X syndrome, fetal alcohol exposure, and epilepsy.
The DSM-5 also includes a new diagnostic category outside of ASD called social communication disorder. The diagnosis is likely to be a good fit for children with severe attention-deficit/hyperactivity disorder (ADHD) and social skills deficits, Dr. Swedo said. One of the criteria for the disorder is that ASD must be ruled out.
Dr. Swedo said she does not expect psychiatrists to experience any confusion about which patients should receive a diagnosis of social communication disorder vs. ASD. During the pediatric field trials for the DSM-5, physicians moved very few children and adolescents with a pervasive developmental disorder (not otherwise specified) diagnosis into the social communication disorder category. Instead, they pick up a significant fraction of new patients, she said.
Somatic symptom disorders
The DSM-5 revamps the diagnostic criteria for somatic symptom disorders, bringing many different somatic conditions into a new disorder known as somatic symptom disorder. In previous versions of the DSM, the different diagnoses had overlapping boundaries, and the criteria ranged from too stringent to too loose, said Dr. Joel E. Dimsdale, chair of the Somatic Symptoms Work Group and professor emeritus of psychiatry at the University of California, San Diego. The result is that physicians felt uncomfortable using the somatoform diagnoses, and patients often went unrecognized and untreated, he said.
Another problem with the old versions of the DSM is that the focus for these conditions was on medically unexplained symptoms, Dr. Dimsdale said.
"It’s not a reliable distinction that clinicians agree about," he said. "It tends to foster an antagonism between the doctor and patient, and furthermore, it really encourages a mind-body split or dualism."
In the DSM-5, the new disorder known as somatic symptom disorder does not make medically unexplained symptoms central to the diagnosis. The major criteria for somatic symptom disorder are persistent (lasting 6 months or more), significant somatic symptoms that are associated with disproportionate thoughts, feelings, and behaviors, such as extreme levels of anxiety.
"I think doctors will have more confidence when they make that diagnosis," Dr. Dimsdale said.
And the new approach will be less alienating to patients, he said. "You will no longer be suggesting to a patient that his or her medical problems are imaginary, and that’s a significant improvement."
Commentary – Independent research review needed for DSM 5.1
Future editions of the DSM need to consider how outside social and economic forces are influencing mental health diagnosis, according to a commentary published in Health Affairs.
In the article, published on April 24, a group of experts in psychiatry, epidemiology, and social science called for the creation of an independent research review body to examine the scientific evidence on how institutional, social, and cultural factors contribute to variations in psychiatric diagnosis (doi:10.1377/hlthaff.2011.0596).
The experts assembled to revise the DSM have the necessary clinical expertise, but another group is needed to look at societal factors, such as how direct-to-consumer pharmaceutical advertising can affect the spikes in diagnoses or how insurance reimbursement rates can incentivize the diagnosis of more serious conditions, they wrote. The proposed research group also could look at the impact of environmental factors, such as the stress of living during a time of war.
"Research along these lines can clarify whether differences in disease diagnosis across groups results from diagnostic criteria, the way the criteria are applied, or environmental factors that influence people’s susceptibility to disorders," wrote the experts, led by Dr. Helena B. Hansen of the departments of psychiatry and anthropology at New York University.
The independent review body would consider differences in rates of diagnoses by sex, ethnicity, income, or geographic area, as well as rapid increase in a specific diagnosis. The review body also would be tasked with recommending changes to the DSM when its diagnostic criteria led to under- or overdiagnosis of a disorder.
The authors of the commentary received financial support from the Robert Wood Johnson Foundation Health and Society Scholars Program.
On Twitter @MaryEllenNY
After years of research, debate, and revision, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is hitting the shelves.
The release of the DSM-5 marks the first time the influential diagnostic manual has been updated in nearly 20 years. The goal in putting together the fifth edition was not to do anything radical, said Dr. Dilip V. Jeste, president of the American Psychiatric Association, but to bring the science up to date and to make it more user friendly for clinicians.
"The goal is to make sure that we have more accurate diagnoses so we can get better mental health services and improve patient outcomes," Dr. Jeste said.
The DSM-5 moves from a multiaxial system to a single axis format. It didn’t make sense to separate the disorders in that way, Dr. Jeste said, and the change makes it simpler for psychiatrists to use. The DSM-5 also puts a greater focus on the roles of age, gender, and culture. Every chapter will include a section on how to apply these factors when making a diagnosis.
Overall, the DSM-5 is not significantly different from the DSM-IV, said Dr. Joel Paris, a professor of psychiatry at McGill University, Montreal, and author of the "The Intelligent Clinician’s Guide to the DSM-5" (New York: Oxford University Press, 2013). Psychiatrists do not need to worry that they will be dealing with a completely new manual, he said, because most of the controversial changes were not accepted in the final version of the manual.
Dr. Paris, who was not involved in the DSM revision, said some those big changes were rejected by the DSM-5’s Scientific Review Committee because they did not have enough scientific data to back them up. "We’re just starting the science of psychiatry," he said. "It’s early days."
But there are some notable changes in the new manual. Experts who worked on the DSM-5 highlighted some of the revisions most likely to affect the way in which how psychiatrists practice.
Mild neurocognitive disorder
In the DSM-5, neurocognitive disorders are divided into two subtypes: mild and major. Major neurocognitive disorder lines up with the DSM-IV definition of dementia. But the DSM-5 Neurocognitive Disorders Work Group created a new subtype to describe mild neurocognitive decline that is more severe than the normal forgetfulness of aging but doesn’t rise to the level of dementia.
The DSM-5 includes specific criteria to help make the diagnosis of mild neurocognitive disorder, said Dr. Dan G. Blazer, cochair of the Neurocognitive Disorders Work Group and a professor of psychiatry and behavioral sciences at Duke University in Durham, N.C.
A patient with mild neurocognitive disorder is likely to complain of memory problems but will not have significant cognitive problems and would not meet the criteria for major neurocognitive disorder. Such patients often are able to complete their daily tasks, but it takes significantly more time and effort. For instance, a patient with mild neurocognitive disorder might take 2 hours to balance a checkbook, when it took just 10 minutes in the past.
Patients with mild neurocognitive disorder should fall somewhere between 1-2 standard deviations below normal on neuropsychological tests, Dr. Blazer said. While the DSM-5 does not recommend a specific test, Dr. Blazer said using some type of standardized test is important. "As we move along in this field, it’s going to be very important to objectively document the level of cognitive impairment that individuals have," Dr. Blazer said.
One of the challenges with this diagnosis is the question of whether these patients will progress and develop dementia. The answer is not necessarily, Dr. Blazer said. While this group has a higher likelihood of progressing to more severe problems, it is not a diagnosis of "pre-dementia," he said.
For many psychiatrists, the biggest change will be to begin asking patients about their level of functioning when they come in with memory complaints. That’s something that can be easily overlooked in a busy practice, Dr. Blazer said.
Major neurocognitive disorder
Previously memory impairment was essential to making a diagnosis of dementia, now called major neurocognitive disorder. But the DSM-5 no longer requires memory impairment to be present, said Dr. Jeste, who served on the Neurocognitive Disorders Work Group and is a professor of psychiatry and neurosciences at the University of California, San Diego.
The change was made to acknowledge that there are major neurocognitive disorders in which memory impairment is not present until late in the course of the illness. For instance, with frontotemporal dementia, which can occur when the patient is aged 50 years, memory impairment does not become apparent until much later in life. Instead, the main symptom is a change in personality. The change will likely reduce the number of patients who receive a "not otherwise specified" (NOS) diagnosis, Dr. Jeste said.
Intellectual disabilities
The DSM-5 removes the term "mental retardation" in favor of a diagnosis of intellectual disability. But the revisions go beyond the name change, according to Dr. Susan E. Swedo, who chaired the Neurodevelopmental Disorders Work Group for DSM-5.
The new definition is based not only on cognitive capacity, but also on adaptive functioning. The DSM-IV included four diagnostic codes for mental retardation: mild, moderate, severe, and profound. But the DSM-5 has only a single diagnosis of intellectual disability. The manual includes specifiers to use when grading the severity level. The specifiers also are based on both cognitive capacity and adaptive functioning.
Dr. Swedo predicted that because the new criteria are "real-world based," it will make it easier for primary care physicians to make a tentative diagnosis.
Autism spectrum disorder
The APA got a lot of attention when it announced plans to combine autistic disorder, Asperger’s disorder, and pervasive developmental disorder NOS into single spectrum called autism spectrum disorder (ASD). But the big change for psychiatrists will be the new criteria for assessing the severity of ASD.
The DSM-5 does not have an overall severity score for autism. Instead of mild, moderate, and severe, ASD is defined in terms of the level of support required. "We had grave concerns that if somebody got a mild autism diagnosis that it would deny [the patient] services," Dr. Swedo said. "If you meet threshold criteria for autism, you have an impairing condition and deserve help."
The DSM-5 also includes a specifier for when ASD is associated with a known medical or genetic condition or an environmental factor. This new specifier was included to encourage clinicians to include information about potential etiologic associations such as Fragile X syndrome, fetal alcohol exposure, and epilepsy.
The DSM-5 also includes a new diagnostic category outside of ASD called social communication disorder. The diagnosis is likely to be a good fit for children with severe attention-deficit/hyperactivity disorder (ADHD) and social skills deficits, Dr. Swedo said. One of the criteria for the disorder is that ASD must be ruled out.
Dr. Swedo said she does not expect psychiatrists to experience any confusion about which patients should receive a diagnosis of social communication disorder vs. ASD. During the pediatric field trials for the DSM-5, physicians moved very few children and adolescents with a pervasive developmental disorder (not otherwise specified) diagnosis into the social communication disorder category. Instead, they pick up a significant fraction of new patients, she said.
Somatic symptom disorders
The DSM-5 revamps the diagnostic criteria for somatic symptom disorders, bringing many different somatic conditions into a new disorder known as somatic symptom disorder. In previous versions of the DSM, the different diagnoses had overlapping boundaries, and the criteria ranged from too stringent to too loose, said Dr. Joel E. Dimsdale, chair of the Somatic Symptoms Work Group and professor emeritus of psychiatry at the University of California, San Diego. The result is that physicians felt uncomfortable using the somatoform diagnoses, and patients often went unrecognized and untreated, he said.
Another problem with the old versions of the DSM is that the focus for these conditions was on medically unexplained symptoms, Dr. Dimsdale said.
"It’s not a reliable distinction that clinicians agree about," he said. "It tends to foster an antagonism between the doctor and patient, and furthermore, it really encourages a mind-body split or dualism."
In the DSM-5, the new disorder known as somatic symptom disorder does not make medically unexplained symptoms central to the diagnosis. The major criteria for somatic symptom disorder are persistent (lasting 6 months or more), significant somatic symptoms that are associated with disproportionate thoughts, feelings, and behaviors, such as extreme levels of anxiety.
"I think doctors will have more confidence when they make that diagnosis," Dr. Dimsdale said.
And the new approach will be less alienating to patients, he said. "You will no longer be suggesting to a patient that his or her medical problems are imaginary, and that’s a significant improvement."
Commentary – Independent research review needed for DSM 5.1
Future editions of the DSM need to consider how outside social and economic forces are influencing mental health diagnosis, according to a commentary published in Health Affairs.
In the article, published on April 24, a group of experts in psychiatry, epidemiology, and social science called for the creation of an independent research review body to examine the scientific evidence on how institutional, social, and cultural factors contribute to variations in psychiatric diagnosis (doi:10.1377/hlthaff.2011.0596).
The experts assembled to revise the DSM have the necessary clinical expertise, but another group is needed to look at societal factors, such as how direct-to-consumer pharmaceutical advertising can affect the spikes in diagnoses or how insurance reimbursement rates can incentivize the diagnosis of more serious conditions, they wrote. The proposed research group also could look at the impact of environmental factors, such as the stress of living during a time of war.
"Research along these lines can clarify whether differences in disease diagnosis across groups results from diagnostic criteria, the way the criteria are applied, or environmental factors that influence people’s susceptibility to disorders," wrote the experts, led by Dr. Helena B. Hansen of the departments of psychiatry and anthropology at New York University.
The independent review body would consider differences in rates of diagnoses by sex, ethnicity, income, or geographic area, as well as rapid increase in a specific diagnosis. The review body also would be tasked with recommending changes to the DSM when its diagnostic criteria led to under- or overdiagnosis of a disorder.
The authors of the commentary received financial support from the Robert Wood Johnson Foundation Health and Society Scholars Program.
On Twitter @MaryEllenNY
