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Psychiatry’s Bible to be revised

Children who throw too many tantrums could be diagnosed with “temper dysregulation disorder with dysphoria.”

world Updated: Feb 11, 2010 00:19 IST

Children who throw too many tantrums could be diagnosed with “temper dysregulation disorder with dysphoria.”

Teenagers who are particularly eccentric might be candidates for treatment for “psychosis risk syndrome.”

Men who are just way too interested in sex risk being labeled as suffering from “hypersexual disorder.”

These are among dozens of proposals being unveiled on Wednesday by the American Psychiatric Association in the first complete revision since 1994 of the Diagnostic and Statistical Manual of Mental Disorders, or “DSM” — the massive tome that has served as the bible for modern psychiatry for more than half a century.

The product of more than a decade of work by hundreds of experts, the proposed revisions are designed to bring the best scientific evidence to bear on psychiatric diagnoses and could have far-reaching implications, including determining who gets diagnosed as mentally ill, who should get powerful psychotropic drugs, and whether and how much insurance companies will pay for care.

The proposals will be debated in an intense process over the next two years, with potentially billions of dollars at stake for pharmaceutical companies, insurance companies, government health plans, doctors, researchers and patient advocacy groups.

But perhaps more important, the outcome will help shape which emotions, behaviours, thoughts and personality traits society considers part of the natural spectrum of the human persona and which are considered pathological, requiring treatment and possibly even criminal punishment.

Even before being made public, the proposed changes have been the subject of sometimes bitter debate over whether the process was based on solid scientific evidence and was adequately shielded from influence by the pharmaceutical industry, and whether some critics were driven by financial interests in maintaining the old diagnostic criteria.

After being posted on the Internet, which of the proposed changes become final will be determined by a public comment period that will last until April 20, studies to validate some of the changes, further review, and votes by the association’s Board of Trustees and Assembly. A final version is expected to be out by May 2013.

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