DSM-V Already Stirrin’ the Pot

January 16th, 2009 | Sources: NY Times

DSM-V will be released 3 years hence, so the nation’s top psychiatrists have already begun debating whether compulsive shopping is a mental problem and Asperger’s syndrome is different from high-functioning autism.

When the answers appear in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, they’ll drive reimbursement policies, research agendas and the self-identity of millions for as long as it takes ‘em to release DSM VI.

“This is not cardiology or nephrology, where the diseases are well known,” said Edward Shorter, an expert on the history of psychiatry and a DSM critic.

“In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” including political, social and financial.

Three particularly contentious areas are gender identity, childhood mental illness and new social addictions like eating and shopping.

The current DSM characterizes transgender people for example as having “strong and persistent cross-gender identification,” which has caused a stir.

Some advocates have circulated petitions objecting to panel members they say have expressed demeaning views on the matter.

Others don’t believe the matter has anything to do with psychiatry and want the diagnosis expunged.

Still others want it to remain in DSM which would help assure insurance coverage for surgeries and treatments.

“The language needs to be reformed, at a minimum,” Mara Keisling told the New York Times.

“Right now, the manual implies that you cannot be a happy transgender person; you have to be a social wreck,” added the executive director of the National Center for Transgender Equity.

The gender identity debate reminded some of the protracted battle to scratch homosexuality from DSM.

In the 1970s, gay activist protests sparked a review resulting in replacement of the word “homosexuality” with “sexual orientation disturbance.” That was later changed to “ego-dystonic homosexuality” before finally being removed altogether in 1987.


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