TORONTO – It’s dubbed as the bible for mental health professionals. It helps determine diagnoses and treatment, what medications and services are covered, and eligibility for insurance. And after a decade of reworking, a major revision to the Diagnostic and Statistical Manual of Mental Disorders – or the DSM – is set for publication next week.
It’s the manual’s first major facelift in nearly 20 years and its revisions are causing some controversy. Grieving could be labelled as depression. Binge eating turns into an illness. And kids with temper tantrums could even be medicated.
Global News takes a look at why you should care about the DSM-5.
The effects seep into Canada
With more than a decade of editing and the wisdom of 1,500 experts from around the world, the DSM has always held some clout in the medical field.
Dr. Oren Amitay, a Toronto-based registered psychologist, says that the manual is referred to more often than patients know.
“We are beholden to the DSM, so whatever happens with the DSM, changes will affect Canadians, so we should be concerned,” Amitay told Global News.
“Psychologists, psychiatrists, any medical doctors that deal with mental health – this is the book that we use.”
Its identification and classification of mental health conditions play a part in diagnosing, medication and treatment, services available to kids and adults, how these therapies are covered and who is eligible for disability insurance and benefits.
The thin line between grieving and depression
Some critics are worried that alterations could spark unnecessary diagnoses.
The new DSM, for example, could morph conventional bereavement into major depression. If you’ve just lost a loved one and you’re experiencing sadness, lack of focus, loss of appetite, trouble sleeping and reduced energy, even for a mere few weeks, you could be labelled with depression.
That mental condition is treated with antidepressants, Dr. Allen Frances says.
“Their grief is medicalized and they would be subjected to medical rituals and pills instead of the traditional consolations from family,” he said.
Frances is a former Duke University psychiatrist and an outspoken critic of the DSM, often penning editorials and chronicling its revision progress online. He was chair of the DSM-IV taskforce and oversaw that revision in 1994.
The former DSM insisted that those who lost a loved one within the past two months shouldn’t be diagnosed with depression, but this update is dropping that time limit.
Diagnosing children and seniors with mental disorders
If your daughter or son is acting up with extreme temper tantrums and you turn to your doctor for help, your toddler or young child could be diagnosed with “disruptive mood dysregulation disorder,” which is a new diagnosis.
Conventional parenting may call these temper tantrums “the terrible twos,” but the APA suggests this new diagnosis is meant to help kids who were once labelled as having bipolar disorder.
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On the other end of the spectrum are seniors. Older Canadians who may have lapses of forgetfulness could now be suffering from “mild neurocognitive disorder.”
In this new diagnosis, experts were trying to strike a fine balance in identifying what could be the precursor to dementia. If you end up with mild neurocognitive disorder, reports suggest there’s a 50 per cent chance you’ll develop Alzheimer’s disease.
Still, critics worry that this label will cause some fearmongering and misidentify “senior moments” as a mental illness.
New mental disorders introduced
One of the most talked about additions to the DSM-5 is binge eating. This is not characterized by a night of glutton while watching the Super Bowl – it’s described as out of control feasting on an inordinate amount of food in a single sitting at least 12 times in three months.
Keep in mind, North Americans, along with much of the rest of the world, are battling steep rates of obesity and lack of exercise. Frances says he estimates that five to 10 per cent of the American population fit the criteria of binge eating, but that doesn’t necessarily mean they have a mental disorder.
Canadian data suggests one in five people living with obesity binge eat.
“It’s medicalizing something that’s a problem, not necessarily a mental disorder. It should not be a psychiatric illness that people eat too much,” Frances said.
Other issues such as hoarding, skin-picking disorder and hypersexual disorder could be additions to new diagnoses as well.
The concern in introducing a wave of “fad” conditions lies in overdiagnosing and treating.
“Once a diagnosis becomes official, it can take on a life of its own becoming terrifically overused and that can have dire unintended consequences,” Frances said.
Some people may face social stigma, others may shirk personal responsibility, and even worse, some patients may be given prescription treatment for illnesses they may not have.