Mental disorders reclassified

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The American Psychiatric Association started a two-year negotiation process as it heard proposals for the fifth version of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). The proposals will be debated, and a DSM-V will be released by 2013. The new edition will recategorize what is considered, and not considered, a mental illness.

Columbia psychiatry professor Michael First, who edited the manual’s fourth edition, is concerned about some of the propososed changes.

One such change is the reclassification of juvenile bipolar disorder to “temper dysregulation disorder with dysphoria.”

“What you call something has a huge implication,” said First. “Certainly the names have treatments associated with them — certain levels of stigma — so the name is extremely important. It actually makes real life difference for patients’ lives and for clinicians.”

First says while the new name, temper dysregulation disorder with dysphoria, may help psychiatrists distinguish the disorder from adult bipolar disorder and provide treatment more appropriate for a child, it may also make the disorder sound less serious than it is.

Susan Resko is the mother of a bipolar child and the executive director of the Child & Adolescent Bipolar Foundation. She says such a change is a good thing for children diagnosed as bipolar, but agrees with First that the name may be misleading.

“There’s been a lot of debate whether bipolar disorder can exist in childhood, and I don’t think this rules it out, but it gives another category for kids who don’t fit exactly into this criteria,”  said Resko. “A lot of people refer to these kids as diagnostically homeless. But the important point, and I agree with Dr. First, is that it’s not just a temper tantrum. These kids are severely ill, they can not function at home or at school, and this disorder, whatever we call it, is ruining lives.”

The new disorders proposed for the DSM is also a concern for Dr. First. One, called “psychotic risk syndrome,” attempts to identify teenagers at risk for schizophrenia.

First says it’s a laudable goal because early intervention could lead to prevention, but he has reservations. “There is no effective intervention, and the way it’s defined, it has the potential of mislabeling millions of teenagers.”

In addition to mislabeling, First says these new disorders have the potential to capture people who have never been diagnosed with a condition before.

“And it’s those disorders which, to me, create the most concern — to make sure that people who don’t have a mental disorder aren’t caught up in the net of having a diagnosis they really don’t have,” he said.

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