New DSM Launches Amidst Controversy
At long last, the new DSM-5—the Diagnostic and Statistical Manual of Mental Disorders, aka the psychiatrist's bible—has been unleashed on the world, and so far the controversy that engulfed it pre-publication shows no sign of abating. The much-debated, fifth-edition update to 1994's DSM-IV made its debut last Saturday at the annual meeting of the American Psychiatric Association in San Francisco. One of the most outspoken critics, Dr. Allen Frances, who headed up the DSM-IV revision—and who later lamented how that edition contributed to "false epidemics" of ADD, autism and childhood bipolar disorder—immediately came out with guns blazing, alleging that it exacerbates "overtreating people with everyday problems who don't need it, [while] shamefully neglecting the people with moderate to severe psychiatric problems who desperately do."
In redefining the diagnosis of addiction, the new DSM combines abuse and dependence—the former binary definition—into a single category called "substance use disorder." Individuals will continue to be diagnosed according to their symptoms, but those symptoms are now based on a spectrum from "mild" to "moderate" to "severe" substance use disorder, as Dr. Charles O'Brien, chair of DSM Substance-Related Disorders Work Group for the DSM-5, wrote for The Fix in April. In another first, a "behavioral" (i.e., non-substance) addiction—pathological gambling—was added to the list of addiction diagnoses. While many clinicians had clamored for the inclusion of other such compulsive behaviors, such as sex or Internet addiction, these disorders were put on hold pending further research. It remains to be seen whether the expanded "spectrum" definition of substance use disorder will lead, as proponents hope, to earlier, more effective and more cost-effective treatment, or, as opponents warn, to the massive overdiagnosis and overtreatment of essentially healthy people with the result that addicts most in need of care will be left out in the cold.