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Ask the Mental Health Expert Archives 2001-2004

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Next DSM

Q. Do you have any idea on when the next DSM is coming out and what additions it will have?

A. I don't have any reason to believe that a new DSM is around the corner, though you may be aware that there is a DSM-IV-TR that came out recently, amounting to a text revision of the original (1994) DSM-IV. This new book does not revise diagnostic criteria or add new diagnoses; it simply updates some of the background research on the disorders. This may set the stage for a full DSM revision in a few years. I can only guess at what additions (or deletions) DSM-V will have, but here are some trends I would watch: in the area of eating disorders, look for "Binge Eating Disorder" to become a full-fledged diagnosis.

In the current DSM-IV, it is relegated to Appendix B ("Criteria Sets and Axes Provided for Further Study"). Also in Appendix B, and possibly moving toward full recognition as a disorder, is Premenstrual Dysphoric Disorder, a more severe form of what is popularly termed PMS (premenstrual syndrome). In the area of dementia and cognitive disorders, there is a good deal of debate over the status of so-called "Age-Related Cognitive Decline" (now listed in DSM-IV under "Other Conditions that May be a Focus of Clinical Attention") and "Mild Neurocognitive Disorder" (see DSM-IV Appendix B). These conditions seem to straddle the boundary between normal forgetfulness associated with aging or medical illness, and the dementia seen with Alzheimer's Disease and similar disorders. I suspect that the next DSM will try to resolve some of this controversy, but I wouldn't bet that everybody will be satisfied.

I also suspect that the framers of the new DSM will be aware that some professionals and many members of the general public are concerned with the seeming proliferation of mental disorders over the past 30 years or so. To be sure, some of the newer diagnoses have been insufficiently supported by rigorous scientific studies--but that does not mean they are merely myths or social labels, attached for the convenience of doctors or parents. Attention Deficit Hyperactivity Disorder is one example: we do need tighter and more objective criteria for ADHD, but I have no doubt that this disorder is really out there. I hope that the next DSM will try to refine the criteria for this condition. And with that, I will conclude my bit of crystal ball gazing!

June 2001

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