DSM-5: diagnosis of mental disorders

Abstract

In the Journal of Mental Health this month, the diagnosis of mental disorders is discussed with focus on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is undergoing draft revisions and is scheduled to be published by the American Psychiatric Association (APA) in May, 2013. Proposed changes to DSM-5 include the addition of autism spectrum disorders, revision to binge-eating disorder, and deletion of some types of schizophrenia. The 11th edition of WHO's International Classification of Diseases (ICD) is expected to be completed by 2014. DSM is mainly used in the USA and for research purposes, whereas ICD is mainly used in Europe and for clinical diagnoses. Although the publication of these editions of DSM and ICD (chapter V for mental and behavioural disorders) will not coincide, they are intended to harmonise the diagnosis of mental disorders.A concern is that inclusion of more mental disorders in DSM-5 might be of greater benefit to drug companies than to the patients and their families. Knowledge of the duration, severity, and context in which symptoms arise—eg, bereavement or loss of livelihood—is needed to distinguish normal human reactions to distress from symptoms of real mental disorders and to avoid false-positive diagnoses of mental ill-health. The benefits of a diagnosis for the patient include a prognosis, and perhaps treatment. The disadvantages include the stigma of a mental illness for the patient and the patient's family; and a diagnosis of a mental disorder in children might mean alienation from peers, or overtreatment with drugs that might have adverse effects.The APA is being open and welcoming feedback for the fifth edition of DSM from mental health professionals and researchers, and from individuals with mental illnesses and their families. This opportunity should not be missed by anyone who might be able to provide input into DSM-5, thereby making a positive difference to people with or at risk of a mental disorder. In the Journal of Mental Health this month, the diagnosis of mental disorders is discussed with focus on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is undergoing draft revisions and is scheduled to be published by the American Psychiatric Association (APA) in May, 2013. Proposed changes to DSM-5 include the addition of autism spectrum disorders, revision to binge-eating disorder, and deletion of some types of schizophrenia. The 11th edition of WHO's International Classification of Diseases (ICD) is expected to be completed by 2014. DSM is mainly used in the USA and for research purposes, whereas ICD is mainly used in Europe and for clinical diagnoses. Although the publication of these editions of DSM and ICD (chapter V for mental and behavioural disorders) will not coincide, they are intended to harmonise the diagnosis of mental disorders. A concern is that inclusion of more mental disorders in DSM-5 might be of greater benefit to drug companies than to the patients and their families. Knowledge of the duration, severity, and context in which symptoms arise—eg, bereavement or loss of livelihood—is needed to distinguish normal human reactions to distress from symptoms of real mental disorders and to avoid false-positive diagnoses of mental ill-health. The benefits of a diagnosis for the patient include a prognosis, and perhaps treatment. The disadvantages include the stigma of a mental illness for the patient and the patient's family; and a diagnosis of a mental disorder in children might mean alienation from peers, or overtreatment with drugs that might have adverse effects. The APA is being open and welcoming feedback for the fifth edition of DSM from mental health professionals and researchers, and from individuals with mental illnesses and their families. This opportunity should not be missed by anyone who might be able to provide input into DSM-5, thereby making a positive difference to people with or at risk of a mental disorder.