Mental Illness Manual Rewritten
Radical Changes Proposed for Diagnosing Mental Disorders
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
"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
"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
"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.