The DSM-5: Coming To Bookstores (& Insurance Companies) Near You 5/13!

DSM-5

The controversial updates to the DSM-5 will be officially unveiled in May of 2013, after over a decade of debate by the APA.

Well, first things first. It’s not “DSM-V.” It’s “DSM-5.” The American Psychiatric Association [APA] has made this extremely clear. They are a modern. A 21st team.

In May 2013 of, when the DSM-5 is unveiled at the APA’s 2013 Annual Meeting in San Francisco, California, we’ll see just how much the APA is keeping up with the times—or trying to re-define them.

There has been one remarkably positive change to the manual, and even gender and body identity activists are pleasantly surprised, myself included. According to the DSM-IV, Gender Identity Disorder (GID) describes people who experience significant gender dysphoria as mentally ill. This includes people who identify s transsexuals, transgender, genderquer, and other gender identities that do not fit with the mainstream idea of strict, gender  duality (e.g., men and women as the only valid sexes). The language is vague, stating those who have GID exhibit, “Long-standing and strong identification with another gender;” long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex;” and that “significant clinical discomfort or impairment at work, social situations, or other important life areas.” (Note this does not apply to individuals who are Intersex).

The DSM-5 omits the GID diagnosis, and will instead states that transgender people with “gender dysphoria,” which communicates the grave “emotional distress” that my result from, “a marked incongruence between one’s experienced/expressed gender and assigned gender,” to be a significant cause. This seeks to take the blame off of trans communities and place it on a more ignorant, wider public—yet does not address  that at all. Considering that LGBT communities, specifically ages 15-24, attempt suicide up to four times more than their heterosexual peers,” largely because of bullying and family rejection, it bares mentioning that prejudice is a highly possible cause.  According to activists, researchers, and writers at ThinkProgress: “This will allow for affirmative treatment and transition care without the stigma of disorder. Earlier this year, the APA also released new health guidelines for transgender patients, as well as a position statement affirming transgender care and civil rights. It should be recognized, at least, that both documents take a more progressive, realistic view of trans identity, and removes—finally—a wealth of hurtful, stigmatizing language. Finally, this “Gender Dysphoria” diagnosis will be moved out of the Sexual Disorders category and into its own. Clearly, some changes slant toward the slightly more progressive indeed, including collapsing two currently separate diagnoses, “substance abuse” and “substance dependence,” into “substance use disorder.”  Linguistically, this places the blame on the disease. Finally.

The development of the DSM-5 has been in the works for over a decade, with the last edition coming out in 1994. Beginning in 1999 and lasting until 2007, the American Psychiatric Association [APA] began serious work on the pre-planning stages for the newest edition of the Diagnostic and Statistical Manual of Mental Disorders. This monumental project necessitated an official Task Force, and Drs. David Kupfer and Darrel Regier were appointed  President and Vice President, respectively; with Dr. William Narrow serving as the Research Director, and subsequent appointments of specific groups and members appointed and announced as significant research and debated continued through out several subsequent years. The changes that have already been made public certainly hold the promise of the APA crafting a more timely and more nuanced manual.

The doctors who have been overseeing the editing of the DSM are presently entering the period of making the final revisions before the May release, but the changes currently being introduced and debated, in all likelihood, are going to be very similar those in the final publication. It has already been approved by the APA.

In an effort to be more inclusive of the entire mental health community, the last stage of the DSM-5, which commenced in June 2012 and lasted for over half a year, included the open-comment period for health care professionals, psychiatric patients and their families, advocates, activists, and other interested groups. In an effort to be more egalitarian and open with the public, Drs. Kupfer and Reier recently issued the following statement:

On behalf of the entire DSM-5 Task Force and the 13 Work Groups, we thank you for making this Web site an integral part of DSM-5′s development. Your involvement in this process has helped to ensure that DSM will continue to assist mental health clinicians advance their understanding and treatment of their patients and the mental disorders that affect their lives.

comedy and tragedy masks

Dr. McGorry, the leading doctor for Australia’s National Youth Mental Health Foundation known as Headspace, stated, “If you use antipsychotics right away, you are hurting the field. It plays into the hands of our critics.” Let’s hope the DSM-5 will bolster this class of thought in American psychiatry.

How these proposed changes will affect positive (or negative) outcomes for those afflicted with behavioral health disorders remains to be seen. As with any publication, it is currently being debated by doctors who have found major faults with the proposals in the latest edition—and, naturally exalted by those who approve of it. The DSM is not the end all/be all of modern psychiatry, but a guide for doctors in diagnosing patients, but the nicknamed “Bible” of the field, basic gold standard for diagnosis, and sometimes exceedingly precise measurements in the decisions of insurance companies to deny or approve funding.

Other highly debated and deeply significant proposed changes regard reframing Autism and the eliminating Asperger’s syndrome; re-drafting of Personality Disorders (i.e., Borderline Personality Disorder) in toto; adding  “Hoarding” as a legitimate Obsessive-Compulsive Disorder illness; and perhaps the most extreme change of all: making intensely serious alteration to the diagnosis of Schizoaffective Disorder—or, more likely, removing it from the manual all together.

The APA has continuously expressed the mission to remove stigmatizing terms, and have failed and succeeded—as one would expect. In just six months, we’ll finally see. Let’s hope they’ve succeeded more than they’ve failed. After all, our futures are intrinsically bound.