Thursday, December 18, 2008

Revising the mental health "bible"

In today's New York Times, there is an article about the new revisions of the DSM, scheduled to be published in 2012 or so. Every edition of the DSM sparks controversy as these psychiatrists hold the "bible" to mental health illnesses in their hands. There are a variety of decisions to be made, including changing semantics, diagnostic criteria, implementing new disorders, and deleting others. It's really not an easy task, and sure as heck, I definitely would not want to be one of those people in the closed door rooms.

This too sparks debate, as the issue of "transparency" comes up. Currently, the revision process is closed to other mental health professionals and the public. Some feel that this rule should be lifted, while others have a fear of criticism. The other big issue is that each of the chosen psychiatrists had to sign a nondisclosure agreement and limit their income to only $10,000 per year from pharmaceutical companies and other sources. Some have felt this was a conflict of interest, especially feeling there was an underlying influence between pharmaceutical companies and doctors' decisions.
Laura posted an LA Times article that speaks about this very issue. More can also be read on the Psych Central blog.

It'll be interesting to see what the new
DSM-V has in store for everyone. Many with eating disorders are especially curious whether the diagnostic criteria will be changed, especially about the exclusion of amenorrhea for anorexia and whether Binge Eating Disorder will be included as an official disorder in the manual. There was also talk of "purging disorder" to be considered.

In general, I think having the
DSM is a double edged sword. It's positive in that it gives clinicians objectifiable criteria and data. However, I think some clinicians rely on it too much. The manual is really only a guidebook and clinicians should be able to feel as though they can give leeway with patients who may exhibit much criteria for a certain disorder even if it is not all of it.

I'm also wondering what happens to those disorders that were named as illnesses but are excluded from the manual revision? My feeling is that it's another way for insurance companies to NOT pay for treatment. On the up side, other illnesses could be "legitimized" or criteria changed so more or less people fall under that disorder.

What's your feeling on the revisions of the
DSM and its current closed door policy?

A few related posts I wrote awhile back:
Eating disorder diagnostic criteria investigated
Diagnostic crossover in eating disorders


Kara said...

I think amenorhora (sp?) should be taken off the criteria for anorexia. There are plenty of people that clearly have anorexia, but still get their periods even at such a low weight.

I didn't know changing the DSM is a closed door policy. Part of me thinks that everyone should have a say, but part of me thinks that nothing would get done if everyone got a say because the opinions would be so varied. I do think that doctors on the board should not take any money from pharmacutical companies at all. Ten thousand dollars is still a lot of dough.

Lindsay said...

Kara, I agree that amenorrhea should be removed from the list; it makes it definitionally impossible for a man to be diagnosed with anorexia!

Also, I might do away with the requirement that you get down to 85% (is that it?) of the "ideal" weight for your height. Not everyone who starves him/herself *DOES* lose that much weight, and it's not because he/she is any less sick than a person who does. It's a matter of individual metabolism.

Tiptoe said...

Kara and Lindsay, I agree with both of you on the amenorrhea criteria. I have always thought it should be taken off. Several clinicians agree as well.

As for weight, yeah, I agree about the 85% ideal body weight criteria as well. By having this criteria, it excludes a lot of people who are suffering. I've known several people who were clearly anorexic but did not reach that 85% ideal body weight criteria. So much of this illness is about the thoughts we harbor.

The closed door policy can be seen on both fronts of good and bad. While I do think there would be much variability in thoughts, I'd still prefer to have the public and other professionals know what was going on. They could easily choose the option not to allow opinions but just post updates on the revision process.

I totally agree with you about psychiatrists taking the pharmaceutical money. That just seems really wrong no matter the amount.