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Mental Illness Manual Rewritten

Radical Changes Proposed for Diagnosing Mental Disorders

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University of Miami psychiatrist Pedro Ruiz, MD, is president-elect of the World Psychiatric Association. As president of the APA from 2006 to 2007, he was involved in appointing members of the task force that wrote the new DSM-V. He's very positive about what the task force has accomplished.

"What we are trying to do is look at all the possible psychiatric diagnoses and to be sure that each one is real and based on scientific research," Ruiz tells WebMD. "It produces a lot of anxiety. Every time there are changes to the DSM, we get nervous. But it is very important that every once in a while we review the research evidence for all the diagnoses we use. And those that do not pass muster must be removed and we must add those that are new."

Ruiz notes that unlike previous versions of the DSM, the DSM-V task force includes members of the world committee and has the explicit intention of bringing U.S. psychiatric diagnoses into line with psychiatric diagnoses listed in the World Health Organization's diagnostic manual, which is undergoing simultaneous revision.

Ruiz notes that there likely will be valid criticisms made of some aspects of the DSM-V but says that the process will carefully evaluate each one.

"For this task force we selected the top people, not just the best in the U.S. but the best in the world," he says. "We have to give them an opportunity to do their work and see what they recommend. If there are errors, we have to give them the chance to correct them."

Ruiz's colleague at the University of Miami, psychiatry professor Ewald Horwath, MD, says the general theme of the DSM-V is to reverse the trend, begun with revision of DSM-I, to keep adding more and more new diagnoses.

"There was in the last couple of editions a feeling that the number of disorders was growing too much and too many behaviors were becoming medicalized," Horwath tells WebMD. "From what I have seen so far, I don't think that is happening in DSM-V. They are being careful to develop an appreciation for the complexities and dimensions of the current disorders rather than creating new ones."

That said, Horwath is happy to see the new TDD diagnosis that will, he says, keep children from being overdiagnosed as having bipolar disorder.

But don't take the experts' word for it. The proposed DSM-V has a web site, www.dsm5.org, where you can see the proposed diagnoses and -- until April 20 -- tell the task force what you think.

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