Manual Steering: New Handbook on Mental Illness

Manual Steering: New Handbook on Mental Illness to be Released in May

Have you ever bought a piece of furniture from IKEA? Or perhaps a video game? Surely you purchased a phone in the last few years. Items like these come with an instruction manual in order to help with ease of use. The manual is also an introduction to any changes from past iterations of the product.

Even mental illness has its own manual, the Diagnostic and Statistical Manual of Mental Disorders, and the fifth edition of it is soon to be released. The American Psychiatric Association (APA) posted a statement on its website in May 2012, saying that "DSM-5 represents the contributions of more than 700 distinguished mental health and medical experts during an extensive and rigorous 14-year development process. The draft criteria have been opened for public review and comment via three separate times throughout the development process to ensure broad perspectives were considered."

The goal of DSM-V is to improve upon previous iterations of the manual. Unlike other DSM releases, the number of diagnoses is not expected to increase from the previous edition. Dr. David Kupfer, the chair of the DSM-V taskforce, announced: "For the first time in the history of DSM, the total number of diagnoses will not grow. (DSM-5′s final count may even fall below that of DSM-III, published more than 30 years ago.)"

With these assurances DSM-V is set to be released in May 2013. The first DSM was released in 1952, and the current manual, DSM-IV, came out in 1994. Clinical psychologist Robin S. Rosenberg notes an increase of 191 new mental illnesses from 106 in the first edition to 297 in DSM-IV. Given this trend, it might seem that DSM-V would contain even more diseases. Instead, the manual seeks to streamline the illnesses already extant by reclassifying some, or moving them to reside as subtypes of other mental disorders.

Take the case of Asperger's syndrome, which can cause children to display signs of trouble in social situations. Prior to 1994, there was no agreed upon classification for Asperger's specifically. Those who showed symptoms were classified as being autistic, or weren't given a designation at all. DSM-IV changed that, giving Asperger's its own place in the diagnostic manual.

That designation is scheduled to change with the publishing of DSM-V. Asperger's is moving to become a subtype of what is now being termed "autism spectrum disorder." Even though new diagnoses are not planned, the APA is reclassifying many diseases, placing them in what it calls "a developmental continuum," so that "[DSM-V] will have a cohesive organization that sequences disorder groups in terms of how conditions relate to one another," as described by Dr. Kupfer.

The newest edition of the manual seems to be about making classification of mental illnesses easier and maybe a little less cluttered. Different people have different ideas about what this does for mental health diagnosis and treatment. Rosenberg explains that using the DSM-IV system, 46.4 percent of Americans would have a mental illness in the course of their lives, but this number might climb even higher using the new version of the manual.

Some of the disorders that have been added in the past have been more medical than mental, which led to classifying people with medical problems as having mental illnesses, Rosenberg notes. This version of the DSM loosens some of the restrictions on the number of symptoms a person displays and how long they are displayed, Rosenberg writes. For a diagnosis of general anxiety disorder, for instance, DSM-IV outlined six symptoms evident in those who had it. A person would have to display/feel at least three of those symptoms, and those symptoms would have to last for at least six months. The new manual only calls for patients to suffer from one of these symptoms for three months in order to be diagnosed with general anxiety disorder.

While many people might want to fight against the stigma of having a mental illness, they may not know about the changes that are being made to the Diagnostic and Statistical Manual. Without knowing the modifications that the APA is making, individuals may think they are being examined with same protocols as previously.

If you are concerned about the changes in diagnostic guidelines for mental illness, one course of action is to pursue studies in the field. Working in psychology can give you opportunities to listen to the problems of others, study patterns of behavior and understand how behavior is conditioned by various factors. Some people who study psychology can end up doing research, analyzing diseases through experimentation, therapy, interviews or surveys. By working within the psychological community, individuals might someday be able to gain sufficient influence to impact the guidelines for diagnosing mental illness.

Manuals are supposed to provide help for those who read them. They should offer a trove of information, and should help someone understand something much better after reading. The Diagnostic and Statistical Manual was created to help health care professionals recognize, understand and classify different mental health diseases. Yet critics such as Allen Frances, M.D., caution that the new edition could lead to mis-labeling, over-diagnosis and over-medication for "everyday problems of life."

About the Author:

Jamar Ramos has been writing poetry and fiction for many years, and earned his bachelor’s degree in Creative Writing from San Francisco State University. For the last three years, Mr. Ramos switched to producing blog posts for and writing professionally as an independent contributor for a number of Internet sites. His creative works have been featured in The Bohemian and The San Matean. He now contributes articles for,, and