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Diagnostic manual changes always controversial

DSM-5 revises vocabulary, recategorizes some behaviors

Hypochondria is out. So are mental retardation and stuttering.

The American Psychiatric Association's (APA) new compendium of mental maladies - the Diagnostic & Statistical Manual of Mental Disorders, the DSM-5 - hit bookshelves on Wednesday. The tome is meant to help psychiatrists, psychologists, and others who treat and study those in emotional distress to use the same language.

That language, which quickly seeps into popular culture, is changing as the organization tries to be less pejorative or categorize distressing behaviors in different ways.

The new vocabulary may be the biggest change that most of us notice. William Jangro, a psychiatrist at Thomas Jefferson University, said patients are unlikely to receive different treatments than they would have during the reign of the current book, the DSM-IV-TR, which came out in 2000.

"I don't think it's going to change what I do a whole lot," he said. "It's not going to change what the patient is experiencing."

Lori Thomas, a psychologist with Associates of Springfield Psychological, thinks there could be some bumps as therapists and insurance companies learn how the new book works. "We're all kind of just waiting to see what the final changes are going to be," she said.

The book and the vast, multiyear process that went into its development have not been without controversy.

Some critics have contended that one change - allowing a diagnosis of depression for some people who are newly bereaved - medicalizes a normal human process. Defenders of that change say some mourners are less resilient than the norm and need access to help for depressive symptoms brought on by a "severe psychosocial stressor."

The decision to think of autism as a spectrum disorder and abandon the separate diagnoses of Asperger's and pervasive developmental disorders had many advocates worrying that some people would lose their label and then their government services. The APA says it expects little change, and Autism Speaks, an advocacy organization, says it is now waiting to see what happens.

The U.S. Autism and Asperger Association still opposes the changes, largely because of fears that people will lose services. The group also foresees billing confusion because the International Classification of Diseases is not changing its classification system for people on the autism spectrum.

Some critics have also argued that the book is an attempt to classify groups of symptoms that will soon be at odds with brain science. APA leaders counter that they did the best they could with current facts.

Regardless, the book, which helps determine insurance payments, is likely to be a must-buy for many mental health professionals. It lists for $199 in hardcover and $149 in paperback.

As for the words you'll start, or stop, hearing, some problems have new names, and others, such as binge eating disorder, were promoted from the back of the book, the realm of interesting ideas that need more support, into the big leagues of the earlier chapters.

The term mental retardation, which has fallen out of favor in other circles as well, has been replaced with intellectual disability. In a move that obviously was not made in the interest of simplicity, stuttering has become childhood-onset fluency disorder. Social phobia has become social anxiety disorder.

Hypochondriasis is gone, in part, the APA says, "because the name was perceived as pejorative and not conducive to an effective therapeutic relationship." Some hypochondriacs will now have somatic symptom disorder. Others will have illness anxiety disorder.

Psychiatrists will no longer have to decide whether people with schizophrenia are paranoid, disorganized, or catatonic.

Because the doctors were worried that too many kids are being diagnosed with bipolar disorder, they created a new label for children who are irritable and often out of control: They will now have disruptive mood dysregulation disorder. Premenstrual dysphoric disorder, basically really bad PMS, is another new depressive disorder.

The obsessive-compulsive chapter now includes hoarding disorder and excoriation (skin picking) disorder. Body dysmorphic disorder, another new condition, refers to people who are preoccupied with perceived flaws in physical appearance.

What used to be called gender identity disorder is now gender dysphoria. This refers to people who are uncomfortable with their biological gender, such as a boy who feels he is or should have been a girl. The APA says the new book "emphasizes the phenomenon of gender incongruence rather than cross-gender identification." Gender dysphoria is not considered a disorder.