The ﬁght over the DSM
The ﬁfth edition of the Diagnostic and Statistical Manual of Mental Disorders
isn't due until 2013, but that has stopped critics.
February 13, 2010
Anew diagnostic manual prepared by the American
Psychiatric Assn. either trivializes serious conditions,
needlessly encourages hurtful stereotypes or succumbs
to political correctness, depending on whom you
Even experts will question one classiﬁcation or another
in the draft ﬁfth edition of the Diagnostic and
Statistical Manual of Mental Disorders, which is why
it's been posted on the Internet for comments years
before its expected publication in 2013. But the
intention of the authors -- to deﬁne more precisely
which conditions require psychotherapy and how
they're related to one another -- is laudable. And some
of the early objections seem rooted more in politics or perception than in science.
For example, some parents of children with Asperger's syndrome, which is characterized by social
unease and obsessive interest in arcane subjects, apparently resent the fact that, instead of being its
own category, Asperger's will be grouped with three other syndromes under the heading "autism
spectrum disorders." That's of concern because they don't want their children labeled autistic.
It's important to be sensitive, but not to the point of minimizing connections that can aid treatment.
Other critics fault the manual for being too politically correct, as reﬂected in terminology changes
such as "gender incongruence" in place of "gender identity disorder" to describe children
uncomfortable with their gender. That and other changes -- such as the replacement of "mental
retardation" with "intellectual disability" -- do seem designed to avoid stigma, but they do so without
changing the meaning, so we don't see anything wrong with that.
The manual is also being criticized for including a supposedly arbitrary inventory of addictions --
gambling and binge eating are in but not sex or Internet overuse. That debate is a reminder that