Changes Proposed In How Psychiatrists Diagnose

By: Lauran Neergaard - AP Medical Writer
By: Lauran Neergaard - AP Medical Writer

WASHINGTON (AP) - Don't say "mental retardation" - the new term is "intellectual disability." No more diagnoses of Asperger's syndrome - call it a mild version of autism instead. And while "behavioral addictions" will be new to doctors' dictionaries, "Internet addiction" didn't make the cut.

The American Psychiatric Association is proposing major changes
Wednesday to its diagnostic bible, the manual that doctors,
insurers and scientists use in deciding what's officially a mental
disorder and what symptoms to treat. In a new twist, it is seeking
feedback via the Internet from both psychiatrists and the general
public about whether the changes will be helpful before finalizing

The manual suggests some new diagnoses. Gambling so far is the
lone identified behavioral addiction, but in the new category of
learning disabilities are problems with both reading and math. Also
new is binge eating, distinct from bulimia because the binge eaters
don't purge.

Sure to generate debate, the draft also proposes diagnosing
people as being at high risk of developing some serious mental
disorders - such as dementia or schizophrenia - based on early
symptoms, even though there's no way to know who will worsen into
full-blown illness. It's a category the psychiatrist group's own
leaders say must be used with caution, as scientists don't yet have
treatments to lower that risk but also don't want to miss people on
the cusp of needing care.

Another change: The draft sets scales to estimate both adults
and teens most at risk of suicide, stressing that suicide occurs
with numerous mental illnesses, not just depression.

But overall the manual's biggest changes eliminate diagnoses
that it contends are essentially subtypes of broader illnesses -
and urge doctors to concentrate more on the severity of their
patients' symptoms. Thus the draft sets "autism spectrum
disorders" as the diagnosis that encompasses a full range of
autistic brain conditions - from mild social impairment to more
severe autism's lack of eye contact, repetitive behavior and poor
communication - instead of differentiating between the terms
autism, Asperger's or "pervasive developmental disorder" as
doctors do today.

The psychiatric group expects that overarching change could
actually lower the numbers of people thought to suffer from mental

"Is someone really a patient, or just meets some criteria like
trouble sleeping?" APA President Dr. Alan Schatzberg, a Stanford
University psychiatry professor, told The Associated Press. "It's
really important for us as a field to try not to overdiagnose."

Psychiatry has been accused of overdiagnosis in recent years as
prescriptions for antidepressants, stimulants and other medications
have soared. So the update of this manual called the DSM-5 - the
Diagnostic and Statistical Manual of Mental Disorders, fifth
edition - has been anxiously awaited. It's the first update since
1994, and brain research during that time period has soared. That
work is key to give scientists new insight into mental disorders
with underlying causes that often are a mystery and that cannot be
diagnosed with, say, a blood test or X-ray.

"The field is still trying to organize valid diagnostic
categories. It's honest to re-look at what the science says and
doesn't say periodically," said Ken Duckworth, medical director
for the National Alliance for the Mentally Ill, which was gearing
up to evaluate the draft.

The draft manual, posted at, is up for
public debate through April, and it's expected to be lively. Among
the autism community especially, terminology is considered key to
describing a set of poorly understood conditions. People with
Asperger's syndrome, for instance, tend to function poorly socially
but be high-achieving academically and verbally, while verbal
problems are often a feature of other forms of autism.

"It's really important to recognize that diagnostic labels very
much can be a part of one's identity," said Geri Dawson of the
advocacy group Autism Speaks, which plans to take no stand on the
autism revisions. "People will have an emotional reaction to

Liane Holliday Willey, an author of books about Asperger's who
also has the condition, said in an e-mail that school autism
services often are geared to help lower-functioning children.
"I cannot fathom how anyone could even imagine they are one and
the same," she wrote. "If I had put my daughter who has a high IQ
and solid verbal skills in the autism program, her self-esteem,
intelligence and academic progress would have shut down."

Terminology also reflects cultural sensitivities. Most
patient-advocacy groups already have adopted the term
"intellectual disability" in place of "mental retardation."
Just this month, the White House chief of staff, Rahm Emanuel, drew
criticism from former GOP vice presidential nominee Sarah Palin and
others for using the word "retarded" to describe some activists
whose tactics he questioned. He later apologized.
AP Medical Writer Lindsey Tanner in Chicago contributed to this

(Copyright 2010 by The Associated Press. All Rights Reserved.)

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