New hints for psychiatrists on the new DSM

Looking for a hint of how psychiatry and psychotropic drug sales might change when the new Diagnostic and Statistical Manual of Mental Disorders--a.k.a. the DSM-V--appears in 2013? You're in luck. Yesterday, the American Psychiatric Association posted some potential guidelines for comment and study at

Here's a quick digest of changes proposed by committees working on the new manual. One of the biggest is the elimination of some specific diagnoses that they view as subsets of broader illnesses, the New York Times reports. Asperger's syndrome, for example, would be folded into an umbrella diagnosis of "autism spectrum disorders," on the milder end of that spectrum. The spectrum idea would be applied a bit differently with a new diagnosis of "temper dysregulation disorder with dysphoria," as an alternative to the bipolar diagnosis in children. And again in another form to symptoms such as anxiety or suicidal thoughts, which can occur with several different diagnoses, as a way to better describe each patient's illness. 

One of the overweening philosophies of the new DSM is avoiding over-diagnosis. Scrips for psychotropic meds have skyrocketed in recent years, leading some critics so say psychiatry has gone diagnosis-happy, classifying people who are merely eccentric or quirky or moody as mentally ill. As the Washington Post notes, the APA thinks the new manual might lead to fewer people being diagnosed with actual psychiatric disorders.

Obviously, that could affect drug sales; fewer diagnoses means fewer scrips. And it's tough to overestimate just how influential changing the DSM could be, experts say. "Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system," and more, Dr. Michael First, a Columbia University professor tells the NYT.

- read the NYT piece
- check out the Post story