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The New Diagnostic Manuals and You!

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Why do professionals have different names for the same thing? Why do they change the name?! All I want is some understanding, is that to much to ask?

Overwhelmed with Information
Credit: pedrojperez

In 2013 the world of Psychiatry and Psychology went into a riotous frenzy.  There was name calling!  There was vitriol!  Some were calling it the end of the professions a we know it!  Others were saying the professions had taken a bold step towards the future!  And most of the world didn't even notice.  Now in 2014 the broader medical community is going through the same thing.  Drama! Anger! Rage!  And again most of the world doesn't notice.

Should you though?  Maybe, but let's talk abut what has everyone in a tizzy.

Within both these communities there are manuals used to make a diagnosis.  If you are being treated for a problem, that problem has a diagnosis, and the manuals are the rule book by which professionals are (supposed) to make those diagnosis.  As you can imagine in a field where so much money is spent and made, there are a lot of people who care deeply about what happens in this, as it effects their wallets, and more broadly people don't like change.

Now add to that two different changes.  Among the broader medical community is the ICD-10 CM.  This is the medical community's manual edited by some more people to fit US protocols.  Already adopted in Europe, it has been put off a couple of times in the US, but is now slated to become fully active in the US in October 2014.  This has some people up in arms.  Partly due to it's complications and partly due to the fact that we don't like to change.

So what's it's effect on you?  I doubt you'll even notice.  I wouldn't worry about it, despite your doctor's complaining.  It's not like longer numbers and more complicated coding has much relevance to the average patient, which is the most significant changes that I am aware of (note: I am not a doctor so I am somewhat an outsider on the ICD stuff).

There's a slight significance to you in the application of the Diagnostics and Statistic Manual 5, or DSM 5.  It's not huge, but there is something there.  The DSM 5, again after being put off a couple of times, was published in 2013.  It replaced the old and beloved DSM-IV-TR, and many are upset.  Some of it is the collective resistant to change, some of it is genuine controversy over groups who have their own agenda wanting their own thing.  And of course there's money.

So what's the effect on you?  Well, they did change some diagnosis names and types.  Some examples:

  • Autistic Disorder, Asperger's Disorder or Pervasive Developmental Disorder NOS then your diagnosis has shifted.  All three of these are now classified under Autistic Spectrum Disorder.  You may have already known this, as most professionals have been using the term for several years, but now it's official!
  • Mental Retardation: Now this is called an Intellectual Disability.  This serves two purposes.  
    • First, we have moved forward down the euphemism treadmill.  "Retard" has been a pejorative for too long, and now we are jumping out of that.  We'll see how long it lasts.
    • Second, it moves it more in a disability categorization, which is seen as a more positive category rather than the more pejorative retarded.
  • Reactive Attachment Disorder- formerly this had two types: Inhibted and Disinhibited types.  Now they are Reactive Attachment Disorder and Disinhibited Social Engagement Disorder.
  • Agoraphobia is no longer tied to panic attacks.
  • Hoarding Disorder is now no longer a subset of Obsessive Compulsive Disorder.  It is important to note that this was not just done because A&E gave hoarders their own show.
  • Gender Identity Disorder is now Gender Dysphoria and no longer classified as a sexual disorder, as the motivation is more about personal gender than it is about sexual function.

One more big change is loss of what was called the "Axis system."  The previous manuals have 5 Axis that you would put diagnosis on: Axis I was most mental health, Axis II was mental retardation and personality disorders, Axis III was medical, Axis IV was social stressors, and Axis V was the "Global Assessment of Functioning" or GAF a 1 to 100 score that was the clinician's estimate on how well the client functioned.  That was done away with, mainly because most clinicians didn't use it much, and when they did they often used it poorly.  On top of that, insurance companies were abusing the GAF as their primary measure on what they would authorize, which lead to questionable use by therapists in their GAF scores.

Another interesting change, from a pediatric standpoint, is the creation of a disorder called Disruptive Mood Dysregulation Disorder.  There's a big argument over whether this really exists, but in defense of the DSM 5, they were smart not to name it what they really wanted to: Stop Diagnosing Children with Bipolar Disorder.  Disruptive Mood Dysregulation is so much more professional sounding.  

There's some more inside baseball stuff.  Some changes in requirements, such as ADHD having more cross-situation requirements but changing the age.  There was a change in some of the descriptions, the subtypes, etc.  Most of these, again, are a big deal to us in the Mental Health world, but really don't register very high on other people's.



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  1. American Psychiatric Association "Highlight of Changes from DSM-IV-TR to DSM-5." DSM 5 Development. 4/09/2014 <Web >
  2. Center for Disease Control and Prevention "International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)." Classification of Diseases, Functioning, and Disability. 4/09/2014 <Web >

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