by Stuart Goldman, MD, Co-Director of Children’s Mood Disorder Program
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is in the draft stages of revising their fifth edition. While the DSM has limitations and at times is a bit controversial in the psychiatry community, it is the official diagnostic guide. The new edition which is scheduled for 2013 has a few suggested changes that could have some impact on your child and family.
1. Asperger’s syndrome will lose its own classification and be merged with Autism.
Differentiating between these two disorders has long been difficult, and the data increasingly concludes that Asperger’s and autism are dimensions of the same illness. There are pros and cons to this merging.
The con is that those diagnosed with Asperger’s might feel more stigmatized by an autism diagnosis (which is generally seen as far more severe). People with Asperger’s feel like they may be quirky and different, but they have their own successes in the world. Many patients with “classic autism” are quite limited and those with Asperger’s may feel like they’re being brought down by an autism diagnosis.
The pro is that the autism diagnosis can give people, particularly very young children, access to a greater range of services. So it may help those on the more autistic side of the spectrum get early intervention and fare much better in life.
2. Instead of diagnosing far too many children with bipolar disorder, a new diagnosis of temper dysregulation with dysphoria will be used to curb the use of the pediatric bipolar label.
Accurately diagnosing pediatric bipolar disorder has been very challenging. None of the prior (or expected) DSM manuals have adjusted the diagnosis for children. In the mid-to-late 90’s, some psychiatrists unofficially broadened the diagnosis to include children with severe temper tantrums and mood problems.
Further study revealed that while there are groups of children with markedly disregulated moods and challenging behaviors they don’t fit the traditional diagnosis of bipolar disorder. In fact, these kids grow up to have problems with depression, substance abuse and behavioral problems, not bipolar disorders. Hence the new diagnosis that captures the two key characteristic problems, angry outbursts and unpleasant mood.
For families it will mean revisiting the treatment that their children are getting and may cause confusion for some. Ultimately being taken out of one of the more poor prognosis categories will be a hope for relief.
3. Cutting will be classified as a mental disorder instead of as a symptom of borderline personality disorder.
People cut themselves for a variety of reasons, but the majority of them don’t have borderline personality disorder. For many young people, cutting has become a culturally acceptable way of dealing with stress. This new classification means that clinicians and families will have to determine if it’s symptomatic of real trouble or just a challenging phase. Moving cutting away from being a symptom of a character disorder (borderline) and into a more defined syndrome will do a great service for some patients.
4. Binge eating is being added as an eating disorder.
While for some, binge eating should not be labeled a disorder, there are those who binge eat to the extent that it causes dysfunction in their lives. Now that it can be diagnosed as a separate disorder from bulimia nervosa, treatment may become more readily available.