Public comment sought on DSM-5 proposals

The American Psychiatric Association is seeking public comment on diagnostic criteria for mental illness as the long gestation of DSM-5 edges towards its delivery in 2013. APA President Dr Alan Schatzberg said the draft criteria represented a decade of effort by 13 working groups and up to 400 individuals, but the revision was still a “work in progress”. Public comment would be accepted until 20 April this year, with the new criteria to be submitted to the APA in 2012 and formally released a year later. Some major proposals include the following: • New categories have been developed for learning disorders, and a single diagnostic category of ‘autism spectrum disorders’ will absorb the current variations of this diagnosis. The term ‘mental retardation’ will be replaced by ‘intellectual disability’. • Current categories of substance abuse and dependence will be replaced by a new category of ‘addiction and related disorders’. It will more clearly differentiate between compulsive drug-seeking behaviour and the normal responses of tolerance and withdrawal that can occur with some prescription medicines. • Gambling will be the sole disorder in a new category of ‘behavioural addictions’. • Scales to assess suicide risk and recognition of high risk states for dementia and psychosis are being considered. • Temper dysregulation with dysphoria has been included as a new mood disorder, to help distinguish these symptoms from bipolar disorder and oppositional defiant disorder. • Criteria for eating disorders are being re-worked, including recognition of binge eating disorder. The APA is also proposing greater use of dimensional assessments that classify the severity of disorders, weakening its current preference for categorical diagnoses. There is also a new emphasis on the links between gender, race and ethnicity and their effect on the experience and expression of mental illness. The draft criteria can be accessed at www.dsm5.org...