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DSM Proposed Changes, Part II: Reclassifying Pediatric Bipolar Disorder

Last month’s cultural competence column covered proposed changes to the Diagnostic and Statistical Manual-V (DSM-V) of the American Psychiatric Association (APA) due out in May 2013. That column detailed the history of change in the manual since the first edition in 1952 and focused on criticisms of the DSM from various perspectives. From DSM-I to the current edition, DSM-IV-TR, the manual has grown in size by about 300% (from106 disorders to 365 diagnoses and from130 pages to 943 pages; APA, 1952, 2000). Criticisms of the DSM have included the lack of validity of diagnoses, that is, the correspondence of a set of symptoms to an agreed upon underlying pathology, and the reliability of diagnoses—given a particular set of symptoms, all mental health professionals will make the same diagnosis (Kendall & Jablensky, 2003). Critics point to the arbitrary differentiation of diagnoses, which leaves it up to individual professionals to make subjective decisions about assigning a diagnosis (Arnold et al., 2004). Another issue raised is that the diagnostic categories reflect a Euro-American point of view and that syndromes common to other cultures are relegated to the last appendix in the current DSM (Alarcon et al., 2009). The influence of market forces, especially the pharmaceutical industry, on the ever more expansive criteria for mental disorders has been raised (Sharfstein, 2005). The criticism has been made that turning life problems or common personality traits into diagnostic categories results in labeling more and more people as mentally ill and creating profit for psychiatry and big pharma (Lane, 2007). Last month’s column concluded by discussing the changes proposed to re-classify Asperger’s syndrome and merge it with autism into an autism spectrum