It’s a controversial and fascinating exercise: Every few years, psychiatrists decide which diagnoses to scrap and which conditions should be recognized as new disorders.
Sigmund Freud
Sixteen years have passed since doctors last took a hard look at who was coming into their offices and how patients' symptoms fit – or didn’t fit – with the diagnoses listed in their seminal book.
Now that book, the Diagnostic Statistical Manual, is getting an update. The proposed changes were posted on a Web site yesterday and will be available for viewing until April 20, the LA Times reported. The doctors are seeking public input on the new disorders they’ve identified.
The potential revision to the manual provide a fascinating peek at unusual traits in society that have become much more usual. The changes track with an intense and trying period of domestic terrorism, information overload and a 6-second news cycle.
A spin through the data suggests to this reader that there are more disorders unique to the very young and very old, the eating-oriented and the addicted.
The manual gives new disorders legitimacy. Doctors use the book when billing insurers (including Medi-Cal and Medicare) for services. And the named conditions send signals to drug companies about what formulas Americans might need.
Here are excerpts from the draft of the manual:
Binge Eating Disorder, associated with: 1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of being embarrassed by how much one is eating 5. Feeling disgusted with oneself, depressed, or very guilty after overeating.
Post-traumatic Stress Disorder in Preschool Children A. The child (less than 6 years old) was exposed to the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways: 1. Experiencing the event(s) him/herself 2. Witnessing the event(s) as it (they) occurred to others, especially primary caregivers 3. Learning that the event(s) occurred to a close relative or close friend* NOTE: Witnessing does not include events that are witnessed only in electronic media, television, movies or pictures.
Cannabis Withdrawal A. Cessation of cannabis use that has been heavy and prolonged B. 3 or more of the following develop within several days after Criterion A 1. Irritability, anger or aggression 2. Nervousness or anxiety 3. Sleep difficulty (insomnia) 4. Decreased appetite or weight loss 5. Restlessness 6. Depressed mood 7. Physical symptoms causing significant discomfort: must report at least one of the following: stomach pain, shakiness/tremors, sweating, fever, chills, headache.
Hoarding Disorder A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items. Accompanied by distress, and/or indecision associated with discarding. B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).
On the flipside, doctors propose leaving these disorders out of the book altogether. (Meaning that we’ve calmed down and warmed up to each other over the last 16 years?)
Agoraphobia Without History of Panic Disorder A. The presence of Agoraphobia related to fear of developing panic-like symptoms (e.g., dizziness or diarrhea). B. Criteria have never been met for Panic Disorder. C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Sexual Aversion Disorder A. Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner. B. The disturbance causes marked distress or interpersonal difficulty. C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction).
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