Abstract
The recent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association has led to much debate. For this forum article, we asked BMC Medicine Editorial Board members who are experts in the field of psychiatry to discuss their personal views on how the changes in DSM-5 might affect clinical practice in their specific areas of psychiatric medicine. This article discusses the influence the DSM-5 may have on the diagnosis and treatment of autism, trauma-related and stressor-related disorders, obsessive-compulsive and related disorders, mood disorders (including major depression and bipolar disorders), and schizophrenia spectrum disorders.
Highlights
It is unlikely that when the planning for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1] began 10 years ago, there was any inkling that the process and the final product would engender such a remarkable level of criticism, rhetoric, and passion as we have witnessed
Classification of stressor-related disorders in childhood has emphasized the impairment associated with abuse in childhood, rather than neglect. Both types of symptoms and their association with neglect are important to recognize. The effects that such changes in DSM-5 will have on clinical practice are yet to be determined, but there is the potential for improved assessment of stressor-related conditions in children, that the criteria are more relevant and appropriate
Especially elderly people with complicated grief, may benefit from this change, possibly by earlier receipt of intensive treatment after having lost a loved one, millions of other people might be unnecessarily labeled as having an illness, and receive treatment that they do not need. Because both human and financial resources in mental health care are restricted, such broadening of diagnostic boundaries always poses the risk that patients with more severe mental illness who are in need of more and expensive treatments do not receive adequate care. This removal of the bereavement exclusion means that clinicians are not required to distinguish between normal grief and major depression any longer, and it may mean that this skill will soon disappear from the clinical training of psychiatry
Summary
Both types of symptoms and their association with neglect are important to recognize The effects that such changes in DSM-5 will have on clinical practice are yet to be determined, but there is the potential for improved assessment of stressor-related conditions in children, that the criteria are more relevant and appropriate. Because both human and financial resources in mental health care are restricted, such broadening of diagnostic boundaries always poses the risk that patients with more severe mental illness who are in need of more and expensive treatments do not receive adequate care This removal of the bereavement exclusion means that clinicians are not required to distinguish between normal grief and major depression any longer, and it may mean that this skill will soon disappear from the clinical training of psychiatry. It plays a role in keeping alive the view that patients are not merely objects to treat but unique beings who have to make sense of and live with their conditions
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