Sneak Peek: Psychiatry’s ‘Bible’ Is Updated After Nearly 20 Years
Mental Health Innovation: Diagnostic and Statistical Manual of Mental Disorders, fifth edition (aka DSM-5). Due out in May 2013 from the American Psychiatric Association, it's the first major update to the manual in 19 years.
Who: Dr. David Kupfer
What He Does: Chair of the DSM-5 Task Force in charge of overseeing the update; professor and chair of the department of psychiatry at the University of Pittsburgh School of Medicine
Why It's Innovative: The publication of DSM-5 will mark one of 2013's most significant moments in mental health. Long-known as the "bible" of psychiatric disorders, the manual was first published in 1952 and is used by psychiatrists and other mental health professionals worldwide to diagnose and treat mental illnesses. Insurers base reimbursements according to what is —or isn't—included in the text. Courts use it. And it's fair to say that social opinions and attitudes are shaped by the book. Revisions to the text are highly anticipated.
The 2013 update is the first time the DSM will be available online. Sections of the manual also be revised as needed, rather than waiting for a major overhaul like this one. "This is going to be a living document," Kupfer says. "We are not going to achieve everything we would like...But we want to set this up as a situation where we don't have to wait 20 years more to make changes."
The new DSM has also made room for the ever-changing nature of scientific research. Section three of the book, he says, will contain cutting-edge material that is not solid enough to become primary diagnostic criteria but are key areas for research. (In the current edition this information is in the appendix.) "Section three is the living part of the DSM document. That is where the action will be," note Kupfer.
He says that five categories will undergo big changes in DSM-5:
• Autism spectrum disorders: Several types of autism will now fall under a single diagnosis.
• Substance use disorders: This is the new term to replace "substance abuse" or "addiction." This category will also better reflect illnesses with a range of severity.
• Eating disorders: In the prior DSM, many types of eating disorders were defined as "not otherwise specified" (NOS), a vague term that meant the diagnosis didn't really fit into any of the main diagnostic categories. A big goal of DSM-5 was to abandon the term "NOS" wherever possible. In DSM-5, Kupfer says, "We are refining all of the eating disorders much better."
• Sleep disorders: These diagnoses will more closely match the way other medical specialties define them.
• Neurocognitive disorders: Diagnostic criteria will closely match that of neurology.
The Problem That Keeps Him Up At Night: "For awhile, I was getting up a little bit at four or five o'clock in the morning [because] we needed to make our decisions....We could debate it for the next ten years. We needed to get in decision mode. Now, everyone feels really good about the decisions that have been made."
Another Great Mental Health Innovation: "This is more of a hope [than a current innovation.] We now clearly have—on the basis of the November election—the ability to implement the Affordable Care Act. There is both an opportunity as well as some barriers to how well that may play out in terms of the delivery of mental healthcare. If there is anything out there that's [a potentially huge innovation], that's number one."
How You Can Take Action: Read DSM-5. Use it. Understand it, stresses Kupfer. "I don't want this book not to be used. I want people to be able to pick it up and use it and go online and use it."
Do you think this updated manual will have a significant impact on mental healthcare? Do you think it'll help some illnesses to get the attention they deserve?