Proposing changes to DSM-IV

I haven’t really been watching the news lately.

Actually, it’s been a long time since I’ve watched the news.

This evening, when I got home from work, all I wanted to do was fall onto the couch and veg in front of the TV. But the sitcom reruns weren’t doing it for me, so I switched it over to CTV news and was surprised when they aired a story on the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (now in its fourth edition, most commonly referred to as DSM-IV).

There are an inordinate amount of changes proposed, which makes sense considering it has not been updated since 1994. The proposed fifth edition won’t come out until 2013, but now’s your chance to have your opinion heard, if you’re into such things.

The draft of the fifth version is here, and the American Psychiatric Association is asking for feedback — not just from doctors and clinicians, but from the public, whether you deal with a mental illness yourself, know someone who does, or just care about these things. One of the big reasons for the changes is to limit the over-diagnosing that is happening more and more, and as so many people become medicated and possibly don’t need to be.

Since I’m interested in how this could possibly affect me, I’m going to focus on the changes to the mood disorders, but it’s interesting to see how they’re planning on changing the diagnosis of autism, Asperger’s, and many childhood onset mental illnesses. There are also new diagnoses being added, including gambling addiction (although interestingly enough sexual addiction didn’t make the cut).

Changes to the mood disorders can be found here. I’m very interested to see what they come up with as a diagnosis and treatment for Premenstrual Dysphoric Disorder.

I’m not going to go over all the changes, as you can take a peek around yourself (and I think everyone should — even if it doesn’t affect you), but I will note the addition of a new mood disorder, Mixed Anxiety Depression. I have a feeling a lot of bipolar people will be incorrectly diagnosed with mixed anxiety depression in the same way that they’re often misdiagnosed with major or clinical depression. I certainly could have (and still could, if you subtract any hypomania) fit the criteria.

I am particularly interested in the addition of a Clinical Anxiety Scale. The APA website states:

There is mounting evidence that co-morbid anxiety and possibly the severity of anxiety symptoms may have a major influence on the treatment outcome of mood disorders, in terms of treatment response and a high risk of suicide and suicide attempts. While co-morbid anxiety disorders diagnosis may be made, they do not capture all of the co-morbid anxiety because of the asymmetry of criteria (e.g. two weeks of criteria symptoms for major depression and 6 months of criteria symptoms for Generalized Anxiety Disorder. Anxiety occurring as a component of a Mood disorder is not captured). Also the severity of the anxiety is not captured by a co-morbid diagnosis. The addition of an anxiety severity dimension may increase clinical awareness and increase the focus of treatment on the severity of co-morbid anxiety as a part of treatment planning, and possibly to the development of more effective treatments for co-morbid anxiety in the mood disorders and perhaps other disorders.

(In case you don’t know, “co-morbid” isn’t as… morbid as it sounds — it just means two or more disorders simultaneously.)

I think that will affect me when this new edition comes out. The fact that anxiety wasn’t considered a priority for me because we were still trying to figure out my medications for bipolar obviously doesn’t help with any anxiety that I do have. It might not be major, but it is there, and to be honest, it’s getting worse.

The suicide assessment dimension is also an important addition. Although those are obviously factors (I would hope) that doctors keep in mind when dealing with mood disorders, it helps to have an actual assessment, rather than Dr. A just asking simply if I’m “safe” to go home alone.

The definition of bipolar II hasn’t changed for me, but I can now say that I definitely have more mixed episodes than anything else. I am surprised they’re not updating the diagnosis of rapid cycling, since so many manic depressives have this. However, bipolar disorder not otherwise specified could take over for a diagnosis of rapid cycling, if I’m reading it correctly, since it relates to having all the symptoms of mania/hypomania and depression, but in shorter durations. So I suppose my diagnosis could change to this, under the new edition.

Anyway, I haven’t read through everything yet, since I just heard about this less than two hours ago. It will be interesting to see how the new edition recommends treatment, if there are changes, or if they do recommend treatment, and how that will or will not affect medications, insurance, even just getting to see a good doctor.

I wanted to make sure everyone reads about it, so we can have our opinions heard. This is a chance to make sure we get the treatment we need and deserve, so give the APA your feedback!

I’ll update more as I read as much of the proposed new edition as I can, and as news about the changes comes out.

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