Unpopular Changes In Mental Health Diagnoses

The tragic shootings of 20 schoolchildren and six of their teachers at the Sandy Point Elementary School in Newtown, Connecticut, has refocused the attention of much of the American public on mental health care. The assailant had been diagnosed with Asperger's syndrome, a psychiatric illness similar to autism. Along with the calls for changes in gun control laws, many Americans are calling for better access to treatment for Asperger's.

In 2013, however, there will be no approved treatment for Asperger's syndrome, because in the DSM-5, the condition ceases to exist.

Asperger's Syndrome No Longer To Be Disease

Asperger's syndrome will be included in a broader diagnostic category to be called autistic spectrum disorder. No one would get psychiatric treatment for Asperger's syndrome. Nor would Asperger's syndrome treatment continue to be covered by insurance. Government programs that help parents of children who have Asperger's would also be discontinued.

But if someone who has Asperger's is re-diagnosed as having a mild, moderate, or severe form of autistic spectrum disorder, there wouldn't be any problems, right?

The question is whether such a person would be diagnosed with an autistic spectrum disorder, since the new category requires:

"Deficits in social-emotional reciprocity; failure to have a back and forth conversation."

Most people who have Aspberger's can hold conversations, and so would not be diagnosed on the autistic spectrum. If they did not get some other psychiatric diagnosis, and maybe even if they did, insurance coverage and government help would cease.

Asperger's is not the only controversial change in the next edition of the Diagnostic and Statistical Manual.

Substance Abuse Disappears as a Disease Category, Too

Substance abuse and substance dependency have been combined into a single diagnostic category, requiring two or three symptoms for a diagnose rather than a single symptom, such as physical addiction.

The upcoming DSM-5 will limit diagnosis of ADHD to children under the age of 12, but it will make it easier to diagnose a child as having oppositional defiance disorder. It will replace the diagnosis of bipolar disorder in children with a new category called "temper dysregulation disorder." It will allow for a diagnosis of depression within the first two months after the death of a spouse or loved one (replacing the older diagnosis of "grief"), and it will no longer stigmatize shamans, witches, and Pentecostal ministers as having a dissociative personality disorder. The old categories of paranoid schizophrenia and catatonic schizophrenia will disappear, and the term "borderline personality disorder" is being replaced with the designation "BPD." 

The new DSM-5 will even add a diagnostic category called "hypersexuality disorder." On the other hand, the American Psychiatric Association rejected a new category called "attenuated psychosis syndrome," which might have allowed for preventive treatment of persons such as the shooters in Tucson, Denver, and Newtown, had they been identified soon enough.

Changes to the DSM have been debated and protested for over 5 years, and disagreement is sure to continue. If you or your family's ongoing medical care depends on a DSM-IV diagosis, however, be sure to consult your mental healthcare provider well in advance of May 2013 to make sure you get continuing support.