Last week after writing about the DSM-V “Temper Dysregulation Disorder with Dysphoria,” I received several emails asking my opinion regarding the proposed merger of autism and Asperger’s disorder into a single ’spectrum’ category.  This change has clearly generated some significant political debate in the media and the blogosphere, with some in favor of the change (see for example Dr. Roy Ginker’s NYT article), while others have expressed reservations about the potential impact that this change may have in the autism and Asperger’s community. So I wanted to keep my contribution to this discussion somewhat removed from the political/social issues associated with the change, and instead focus on the scientific/clinical basis for this specific move.  Thus, my aim with this post is not to take a position for or against the proposed DSM-V changes. Instead, I simply want to provide some background information about some of the research data and clinical issues that may have contributed to the DSM-V committee’s decision to propose the merger of all ASDs into a single category. Read More

Today the American Psychiatric Association released a draft of the major changes that are expected in the new version of the Diagnostic and Statistical Manual of Mental Disorder – 5th Edition (DSM-V). While most people in the field will be underwhelmed by the relatively minor changes,  there are a few areas where the DSM-V will likely make some drastic changes.  Today most of the news coverage was focused on the proposed changes to the Autism diagnosis, which has raised some heated debate in the autism community. However, there is another major change that has received little, if any, attention: the clarification that a syndrome that in recent years has been labeled childhood bipolar disorder is actually NOT bipolar disorder. Instead, a new disorder category was created: Temper Dysregulation Disorder with Dysphoria (TDD). Read More

As I interact with colleagues I sense an incredible, almost exuberant, level of excitement and anticipation for the DSM-V. “It will change psychiatry”, “it will answer the questions”, “it will abandon categories”, etc, etc, etc. The expectations are so great and in so many directions, that I can’t help but to think that the DSM-V will inevitably disappoint most. Some will complain that it went too far, some will say it did not go far enough. Most likely, as one of the DSM-V committee members recently said, the “DSM-V will be an awkward transitional instrument” because the goals are too great, the changes too drastic, for all of it to be completed in a single sitting; even if the sitting took 17 years.

So today I want to touch on a topic raised by renowned child psychologist Dr. Thomas Achenbach in a recent issue of the journal Psychology Clinical Science and Practice. This topic, the role of “functional impairment” as a component of the diagnostic process, will likely become the elephant in the room, and a source of much tension and debate. Read More