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Medical Manual Changes Designation Of Some Autistic Disorders

Dr. Timothy Murphy, a member of the San Diego Psychiatric Society and president-elect of the California Psychiatric Association, talks to KPBS about changes to the Diagnostic and Statistical Manual (or DSM-5).


Dr. Timothy Murphy, Assembly Representative, San Diego Psychiatric Society; President-elect California Psychiatric Association

Nicole Hope-Moore, President-elect, Autism Society of San Diego


The fifth edition of the Diagnostic and Statistical Manual (or DSM-5) compiled by the American Psychiatric Association was released to the public last weekend. And it's causing quite a bit of controversy.

The new edition of this manual changes the designation of some autistic disorders, and some critics say it changes normal activities like overeating and grief into new illnesses of the mind.

Dr. Timothy Murphy, a member of the San Diego Psychiatric Society and president-elect of the California Psychiatric Association, told KPBS that it's been 19 years since the previous edition was released.

"Over time, problems emerge," he said. "We see clustering of symptoms across diagnostic categories. Genetic information sometimes doesn't align with the categories that we've been using. There's other diagnoses that are hardly used at all, and we have not otherwise specified tags when symptoms don't quite meet criteria for our existing diagnoses, and when we end up using the tag too often, it tells us that we're not capturing the diagnoses we should.

"So it was time to update, and it was a very long process," he added. "It began many years ago, first establishing how the task would be approached by the American Psychiatric Association, and then identifying the people best to write it. It was important to have people who were not only experts in the field but also not encumbered by conflicts of interest with pharmaceutical companies or other entities that might compromise or make their involvement appear to be compromised."

Grief could now be classified as a depressive disorder using the manual, which some say is too extreme.

Murphy said some people who experience a loss have symptoms of grieving that do not reflect an illness, and those people do not need treatment.

"But some individuals after a loss develop much more severe symptoms," he said. "They lose the ability to experience pleasure, their interests disappear, they lose their ability to function in a normal way in their lives. And this continues on for many weeks, sometimes months, and it is evident that that kind of grief is a special circumstance that is difficult to distinguish and in fact may not be distinguishable from a major depressive episode. So drawing attention to that makes it clear that there are some grieving individuals whose symptoms are so severe that they really require treatment."

The new manual also makes binge eating disorder a recognized mental disorder. It is defined as excessive eating at least 12 times in three months.

Murphy said to meet the definition, the eating needs to be accompanied by significant clinical distress.

"I understand from those who have studied it, that it's clear that there is a subset of people whose lives are very much impaired by their inability to control their bingeing," he said.

Asperger's syndrome is also being incorporated into a new autistic spectrum disorder in the new manual. Nicole Hope-Moore, president-elect of the Autism Society of San Diego, told KPBS the change has caused concern in the local autism community.

"They're just concerned about how these changes are going to affect how they access services through their different regional centers and insurance," she said. "Those types of things we do not have any direct control over. Our purpose is just to support the families out there and get them access to the community organizations, research and agencies. But parents are very concerned."

Murphy said until now, the autism spectrum has been divided into three primary syndromes: autism, Asperger's disorder and pervasive developmental disorder.

"It has been accepted, I think for sometime, that Asperger's was related to autism, that individuals with Asperger's disorder, although generally functioning at a much higher level, many individuals with Asperger's have jobs, careers, are involved in the arts, they get married, have families," he said. "But they also have had symptoms which mirror some of the symptoms in autism disorder. And what the workgroup found as they studied this, in fact they referred to a mountain of evidence that there is really no real scientific difference between these disorders except for the fact that individuals with Asperger's disorder have very high functioning autism. They are brighter, their symptoms are milder, and they have much higher rates of success in various spheres of their lives."

Claire Trageser contributed to this report.

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