The DSM—or Diagnostic and Statistical Manual of Mental Disorders—is known as the “bible” of psychology and psychiatry because it contains the criteria needed for diagnosis of each mental disorder. It has not been revised in almost twenty years, and the new version, the DSM-5, set to come out in May 2013, is likely to create entirely new disorders such as hyperactive sexual disorder, gambling behavioral addition, hoarding disorder (which public health officials are happy about because of the public risk—animal hoarding, fire trap, oh my!), ADHD in older teens and adults (previously considered a problem of children), anxious depression, and binge eating disorder (previously just in the appendix). Some claim that these new disorders are unnecessary and will result in over diagnosing and excessive prevalence rates. The DSM task force claims that additions are necessary because, for example with anxious depression, more than 50% of people with depression also have anxiety and that mixed group has shown the poorest response to medication. Similarly, the DSM says that merging Asperger’s Syndrome into the Autism Spectrum disorders will grant more access to services. Others, however, such as the proud support group “Asbies,” want to protect Asperger’s as its own disorder. The new DSM is also expected to reduce personality disorders from 10 to 6—eliminating dependent personality disorder, paranoid personality disorder, histrionic personality disorder (acting very emotional and dramatic to get attention), and schizoid personality disorder (lifelong pattern of indifference to others and social isolation). Will disorder additions and eliminations mean more services for some and less for others? Do new disorders exist and ones we previously thought existed not actually exist? Are some of these new disorders medicalizing human behavior?
Darrel A. Regier, M.D., vice chair of DSM-5