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New psychiatric ‘bible’ expands mental disorders

Is feeling blue when your spouse dies indicative of depression – or just part of the normal grieving process? It ought to be clear that distresses experienced by virtually everyone at one time or another are not mental illnesses.

A revision of an influential diagnostic manual plans to categorize a wide range of apparently everyday behaviours as mental health disorders, causing considerable controversy in the psychiatric community. This edition, known as the Diagnostic and Statistical Manual-5, makes formal diagnoses for shyness and temper tantrums in children, premenstrual irritability; loneliness; Internet addiction; and neuro-cognitive loss in the elderly.

Giving labels to behaviours and feelings that are simply part of the human condition may do more harm than good. There is a danger in viewing persistent insolence in six-year-olds, or a grandmother’s forgetfulness, in such a light. Not every severe emotion is a sign of mental disturbance.

The manual is not, however, meant to be used in isolation. While diagnostic criteria are an important and influential guide, they are only one component in understanding a patient’s experience. “The manual is not a cookbook to be used mechanically,” notes Dr. Susan Abbey, a past president of the Canadian Psychiatric Association. “You have to look at how impaired people are, and how much they are suffering.” Everyone reacts differently to stressful events such as the loss of a child, spouse or job. A good psychiatrist or psychologist assesses a patient over time to see whether their symptoms interfere with their ability to work and maintain relationships.

The manual, published by the American Psychiatric Association, may have more of a role to play in the U.S., where the private health-care system requires a diagnosis in order for the patient to receive treatment and qualify for reimbursement by their health insurer. It will be officially launched in May, 2013.

In the meantime, the APA should be congratulated for posting DSM-5 drafts on its website ( Feedback from the mental health community, scientists and researchers can help to fine-tune it. While medicalizing ordinary distress is certainly not helpful, an updated manual that helps people in pain at a pathological level is welcome. The loss of a beloved, life-long partner may indeed trigger depression in some people, and the sooner they receive treatment, the better.