The American Psychiatric Association unveiled this past week the fifth edition of its handbook of diagnoses, the D.S.M-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition), after 14 years in the making.

This article in The New York Times neatly summarizes a major, on-going discussion over the publication. Per the author,

The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.

Psychiatrists tend to treat according to symptoms. However, the manual carries a fair amount of clout with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits. Sometimes a diagnosis of a condition like autism, A.D.H.D. or conduct disorder is necessary for students to qualify for special therapies. And diagnoses also figure in disability determination.

As noted, the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.

There are definitely changes in the D.S.M.-V over the fourth edition, and as the article notes much of this this will most likely change as researchers learn more about genetics, brain circuitry and cognitive data to fashion better guides to what to prescribe for patients, and in terms of what new compounds to develop. Read more…