Redefining Crazy: Changes To The Bible Of Psychiatric Disorders

On Saturday, the American Psychiatric Association (APA) finalized a 13-year process of revising the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM, the most important book in the field of mental illness. The DSM attempts to designate and code all the ways our minds can go awry. It defines depression, anxiety, schizophrenia — as well as more than 300 other problems from obsessive-compulsive disorder to stuttering to fetishism. Insurance companies require DSM codes for reimbursement, and the National Institutes of Health require them for research grants. It’s no exaggeration to say that the new DSM — the fifth full edition, one that more than 1,500 mental-health experts help write — will change the world of mental health.

Here are some of the biggest changes:

1. Autistic disorder will become autism-spectrum disorder. That spectrum will incorporate Asperger’s syndrome, which generally involves milder forms of autism’s social impairments and previously had its own code number (299.80). To guide clinicians, the DSM will include specific examples of patients meeting criteria for the different disorders making up the spectrum, from autistic disorder to Asperger’s, childhood-disintegrative disorder and pervasive developmental disorder (not otherwise specified). Combining autism and Asperger’s is especially controversial partly because autism can be so much more serious than Asperger’s. Although some autistic people function extremely well (the livestock expert Temple Grandin has helped change her field), others affected by the disorder need lifelong care for basic needs. The change will likely cause considerable debate, however, since the diagnosis is a requirement for access to some of the educational and social services that make up this care, and it’s not clear yet how the change in definition will affect such eligibility in the future.

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