If Romney Can Do It. . .The DSM 5 Changes Its Mind

Posted on May 9, 2012 by

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I’ve now received upmteen notices, through various family, friends, and psychiatric publications, that the DSM 5 has made an about-face.

It’s not the first, by a long shot. Remember the narcissists? Out one day–back in the next? That was a good switcher-oo.

And now, it seems, the Committee has dropped two diagnoses considered somewhat controversial.

One of them out on its ear is “attenuated  psychosis syndrome,” used to describe children with at high-risk of developing schizophrenia.

Apparently this one was a bit problematic since research has indicated that only about 8% of those determined to be high-risk actually go on to develop the schizophrenia–seriously undercutting the validity of the disorder. It’s kind of an ‘oops’ moment.

Wrote the Committee:

The APA is no longer considering “Attenuated Psychosis Syndrome” as a new official disorder in the DSM-5. The proposed diagnosis was supposed to help identify children at risk for developing a psychotic disorder, but research has shown that 2/3 of children who qualify as “at risk” never progress to true psychosis.

If you remember Allen Frances from previous posts, the editor of the DSM-IV, and the full-time critic of the current DSM process, he was like a cat who’d swallowed the canary when he heard about the reversal:

The world is a safer place now that ‘Psychosis Risk’ will not be in DSM-5. Its rejection saves our kids from the risk of unnecessary  exposure to antipsychotic drugs (with their side effects of obesity, diabetes,  cardiovascular problems, and shortened life expectancy). ‘Psychosis Risk’ was  the single worst DSM-5 proposal — we should all be grateful that DSM-5 has finally come to its senses in dropping it.

The second concern was with ‘mixed anxiety depressive disorder,’ which had lower criteria for both the depression and the anxiety components to meet the diagnosis, and thus would have led to over diagnosis of people who were managing without a psychiatric label.

Second update from the APA DSM-5 committee:

The APA is no longer considering “Mixed Anxiety Depressive Disorder” as a new official disorder in the DSM-5. Many psychiatrists worried that the new diagnosis was too vague and that too many people would qualify.

Under the diagnosis itself, they write,

the condition is being recommended for further study in Section III, which is the section of the DSM-5 text in which conditions that require further research will be included.

Bingo. Seems we have enough of run on our mental health system without creating diagnoses so vague that we’ve all got them.

The DSM 5 Committee actually published a “DSM-5 Draft Criteria Open for Final Public Comment,” open through June 15th, noting some changes, and providing opportunity for comment. Peruse it, and avail yourself of the opportunity.

David Kupfer, chairman of the current task force, claimed the changes made just demonstrated how the Committee was open to outside input. He said,

We have not made decisions ahead of time. I am spending 24-7 with 160 colleagues trying to do the best we can to listen to everybody.

Frances has some alternative views. He suggested the turnabouts might be:

 attributed to the combination of: 1) extensive criticism from experts in the field; 2) public outrage; 3) uniformly negative press coverage; and, 4) the abysmal results in DSM 5 field testing,

and then goes on to catalog a list of problems that the Committee should attend to post-haste, now that their eyes have been opened.

We’ll wait to see who has the last word. . .

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