Updated DSM Expands Definition of Depression, Among Other Changes

DSM updates

Recent changes to the diagnostic handbook used by mental health practitioners include broadening the definition of depression, expanding the definition of autism and adding disorders on binge eating and one that is sometimes referred to as the “tantrum disorder.”

The American Psychiatric Association (APA) recently finished revising the Diagnostic and Statistical Manual of Mental Disorders (DSM), the essential text used by psychologists and psychiatrists for identifying and diagnosing mental illnesses.

The Fifth Edition of the DSM                 

For the last 13 years, the APA has been working to define and code different variations of mental illnesses in order to provide an up-to-date, fifth edition of the DSM, applying current research and trends to explain its understanding of how the human brain works and fails to work.

The changes reflect how doctors interpret irregular behaviors, helping to identify symptoms and signs of disorders ranging from anxiety and depression to bipolar. Additionally, insurance companies use DSM codes for reimbursement, and the National Institutes of Health require codes for research grants.

Changes to the DSM include both expanding definitions and removing categories where there is not enough conclusive evidence to include the disorder. This edition’s changes include:

  • Changing autistic disorder to autism-spectrum disorder, which includes Asperger’s syndrome.
  • Adding binge-eating disorder, defined as excessive eating 12 times in three months.
  • Adding categories for excoriation (skin picking) and hoarding.

Depression, Bereavement and Bipolar

The DSM has also expanded its definition of depression to include bereavement. In the past, bereavement was listed as an exception to a depression diagnosis, but now those who lose a loved one can be diagnosed as suffering from major depressive disorder (MDD).

Previous to this edition, skeptics had already criticized the APA for having a definition for depression that was too broad. The concern is related to labeling healthy people with a depressive diagnosis and over-prescribing antidepressants and antipsychotics — especially after people have experienced symptoms of bereavement for as little as two weeks.

Another of the changes relates to over-diagnosis of bipolar in children. In an effort to prevent these incorrect diagnoses, the APA added a new category called disruptive mood dysregulation disorder (DMDD), which addresses children who are consistently irritable and have behavioral outbursts. Critics worry that since these characteristics may be present in a majority of young children, it may lead to over-diagnosis yet again.

Depression Medication

An expanded definition of depression may lead to more diagnoses and more prescriptions for antidepressants. As of 2011, according to the Centers for Disease Control and Prevention (CDC), 11 percent of Americans age 12 or older took antidepressants. As this number may continue to rise, patients should be aware of the risks associated with certain antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

SSRIs are the most common type of antidepressants and have proven effective for many people. Zoloft, Prozac and Paxil are examples of SSRIs. Unfortunately, SSRIs are associated with serious side effects, specifically birth defects if taken during pregnancy.

Infants born to mothers taking SSRIs have been born with birth defects such as cleft lip and palate; heart defects; and persistent pulmonary hypertension of the newborn (PPHN), which can be fatal. Also, both men and women taking SSRIs may experience increased suicidality (suicidal thoughts or behavior), when beginning the medication.