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Mental Illness Manual Rewritten

Radical Changes Proposed for Diagnosing Mental Disorders


First likes a lot of what he sees in the new DSM-V. For example, he likes the new manual's emphasis on suicide prevention, and its effort not just to diagnose a disorder but to give a clearer idea of its severity.

On the other hand, First is disturbed by the proposed diagnosis of people as having risk syndromes for psychosis and dementia.

"Psychotic risk syndrome is the worst idea in the whole thing," First says. "Only 10% to 20% of people who meet the criteria for risk will actually become psychotic. That means that eight in 10 will get no benefit -- and what is the benefit? There is no way to prevent schizophrenia. And then there is the stigma. ... And the potential for normal people being captured under this rubric is high."

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.

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