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An updated edition of a mental health bible for doctors may include diagnoses for “disorders” such as toddler tantrums and binge eating, experts say, and could mean that soon no-one will be classed as normal.
Leading mental health experts gave a briefing on Tuesday to warn that a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is being revised now for publication in 2013, could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.
Citing examples of new additions like “mild anxiety depression,” “psychosis risk syndrome,” and “temper dysregulation disorder,” they said many people previously seen as perfectly healthy could in future be told they are ill.
“It’s leaking into normality. It is shrinking the pool of what is normal to a puddle,” said Til Wykes of the Institute of Psychiatry at Kings College London.
The DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It is seen as the global diagnostic bible for the field of mental health medicine.
The criteria are designed to provide clear definitions for professionals who treat patients with mental disorders, and for researchers and pharmaceutical drug companies seeking to develop new ways of treating them.
Wykes and colleagues Felicity Callard, also of Kings’ Institute of Psychiatry, and Nick Craddock of Cardiff University’s department of psychological medicine and neurology, said many in the psychiatric community are worried that the further the guidelines are expanded, the more likely it will become that nobody will be classed as normal any more.
“Technically, with the classification of so many new disorders, we will all have disorders,” they said in a joint statement. “This may lead to the belief that many more of us ‘need’ drugs to treat our ‘conditions’ — (and) many of these drugs will have unpleasant or dangerous side effects.”
The scientists said “psychosis risk syndrome” diagnosis was particularly worrying, since it could falsely label young people who may only have a small risk of developing an illness.
“It’s a bit like telling 10 people with a common cold that they are “at risk for pneumonia syndrome” when only one is likely to get the disorder,” Wykes told the briefing.
The American Psychiatric Association did not immediately respond to a request for comment.
The scientists gave examples from the previous revision to the DSM, which was called DSM 4 and included broader diagnoses and categories for attention deficit hyperactivity disorder (ADHD), autism and childhood bipolar disorders.
This, they said, had “contributed to three false epidemics” of these conditions, particularly in the United States.
“During the last decade, how many doctors were harangued by worried parents into giving drugs like Ritalin to children who didn’t really need it?,” their statement asked.
Millions of people across the world, many of them children, take ADHD drugs including Novartis’ Ritalin, which is known generically as methylphenidate, and similar drugs such as Shire Plc’s Adderall and Vyvanse. In the United States alone, sales of these drugs was about $4.8 billion in 2008.
Wykes and Callard published a comment in The Journal of Mental Health expressing their concern about the upcoming DSM revision and highlighting another 10 or more papers in the same journal from other scientists who were also worried. DSM 5 is due to be published in May 2013.
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Despite what many social observers have described as a generally dark and brooding take on life, a new report suggests that Russians are actually less likely than Americans to be depressed.
In fact, researchers have uncovered indications that the Russian cultural tendency to dwell on the negative may ultimately insulate them from feelings of distress when engaged in self-reflection.
“Among Westerners, focusing on one’s negative feelings tends to impair well-being, but among Russians, that is not the case,” study co-author Igor Grossmann, a doctoral candidate in psychology at the University of Michigan, said in a university news release.
“Russians focus more on their negative feelings than Americans do,” Grossmann explained, “but they spontaneously distance themselves from their emotions to a greater extent than Americans, who tend to immerse themselves in their recalled experiences.”
Grossmann and co-author Ethan Kross, a University of Michigan assistant professor of psychology, published their findings in the August issue of Psychological Science.
Grossmann and Kross reported on two studies, funded by the U.S. National Institute of Mental Health, that explored cultural influences on depressive tendencies.
The first study focused on 168 Russian and American students who underwent testing to measure their degree of brooding and depressive symptoms. While the Russians were found to brood more, they also displayed fewer indicators of depression than their American counterparts.
The second study involved 162 students who were measured for distress after being asked to remember and discuss a not-too-distant unpleasant memory involving themselves and another individual.
The Russians appeared to experience less distress than the Americans after retelling the experience, and placed blame less often on the person involved in the incident. The Russians were also able to immediately distance themselves from their recollections, even while discussing them — a skill linked to less distress and feelings of blame, the study authors noted.
Culture, concluded the authors, has an impact on the emotional and cognitive consequences of bad experiences.
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