How mental health professionals diagnose their patients could be changing and therefore affect patients, families, and caregivers after 2013.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders that is used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has been designed for use across clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care), with community populations. A wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors can use it. It is also a necessary tool for collecting and communicating accurate public health statistics.
Anticipated changes to the DSM (now commonly referred to as the DSM-5) will go into effect in May 2013 and have been generating a fair amount of controversy.
"It's complicated for family members," said Ken Duckworth, Medical Director of the National Alliance on Mental Illness. "They want to make sure people are getting help."
Changes to the DSM-5 will be the first to the manual in 17 years, and might affect everything from research and treatment to insurance coverage.
One of the more hotly-debated changes is in the autism diagnosis. The proposed changes include a recommendation for a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.
"For some people it may enlarge their access to treatment," said Darrel A. Regier, M.D., M.P.H. and Director for the Division of Research at the American Psychiatric Association and Vice-Chair of the DSM-5 Task Force and Director of the American Psychiatric Institute for Research and Education.
Across websites devoted to autism and in other public forums, people have been expressing fear and concern that eliminating specific autism diagnoses might eliminate access and treatment for loved ones. The goal of the proposed changes is have more accurate diagnoses -- not just of autism, but many mental disorders -- and therefore better treatments.
Considering that studies have shown that family caregivers are at a higher risk for depression than non-caregivers, it's also important to note proposed changes to how major depression is treated by clinicians.
"I think caregivers are at a increased risk for depression because of the persistent stress level they are under, " said Dr. Regier.
The DSM-5 will highlight a link between depression and anxiety, a combination that can mean a patient is at an increased risk for developing a "treatment-resistant illness" and higher risk for suicide. "The DSM does not specifically have treatment guidelines," said Dr. Reiger. "It helps clinicians recognize what is clinically meaningful when prescribing a course of treatment."
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