DSM-5 will capture the dynamic nature of mental illness

From the 20 July 2012 post at KevinMD.com

Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing.

 

Historically, disorders were classified in DSM by symptom manifestation and patient presentation. As a result, they generally were grouped by discreet stages of life, as if there were no connections or implications from one stage to another. In particular, the opening chapter of DSM-IV, “Disorders Usually First Diagnosed in Infancy, Childhood, Adolescence,” segregated such conditions as attention-deficit/hyperactivity disorder, pica, rumination and autism disorder from the rest of the manual. The implication was that disorders in the “child” chapter affect only children and disorders in the rest of the manual affect only adults….

 

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he need for these changes is obvious: The real world doesn’t work within distinct boundaries, and clinicians are not best able to understand potential connections, interrelations and ramifications when they only consider a single, narrow point in time. A young girl who lashes out with persistent and significant anger could presage a young adult with similarly explosive behavior, for example. Conversely, a middle-aged man’s extreme anxiety might reflect a difficult recent event, such as a divorce or layoff. But it also might be a problem that first manifested itself decades earlier, in panic attacks or a fear of leaving the house. In both cases, diagnosis as well as treatment will be more clinically useful if the factors involved are evaluated through a longitudinal lens.

This different perspective will especially benefit women, for whom mental disorders are often linked to specific ages or periods of life. We know that young women between 15 and 22 are much more likely to have negative body image than young men and to develop eating disorders, low self-esteem, depression, self-harm and,  in the most extreme cases, suicide. But what happens after 22?  Even with treatment, the risk of recurrent depression remains, and it often needs to be assessed in terms of the extra emotional and physical issues many women face throughout their lives—because of lower income, discrimination, sexual harassment and violence….

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