Thursday, July 18, 2013

Changes in the DSM V, Part Two

This is the second part of our series on changes in the DSM V - the Diagnostics and Statistics Manual that determines how most of us get diagnosed and funded for our treatments. It’s bound to be a little dry, but I feel that this is information we all need to have access to, since it effects us directly, and impacts our futures.

The Disorders I will tackle today are Bipolar and Major Depressive.

There are fewer changes to Bipolar Disorder than there were in the Schizophrenic and Schizoaffective categories. The primary change is a general increase in flexibility. For instance, in terms of detection, the emphasis now is not so much on specific exact symptoms of X degree, but on changes from the norm in terms of activity, energy, and mood. It is not so much how fast you go, so to speak, it is the fact that you have speeded up from your previous level of activity, speech cadence, etc. This should certainly help with earlier alerts that something is wrong.

Also, the category “mixed episode,” which used to mean an active episode of the disorder containing full features of depression and full features of mania, has now been replaced by the looser term “with mixed features.” The difference here again is one of flexibility. Mixed features can contain a little of this and a little of that in varying doses. You can see how the former definition in which “full criteria” had to be met would be limiting, when in fact symptoms can mix and match in all sorts of unique ways from person to person.

Thirdly, the category “Other Specified Bipolar and Related,” a sort of catch-all category, has been opened up more in terms of whether a hypomanic episode is “long enough” or has “enough symptoms” to diagnose.

Lastly is the addition of a new “with Anxious Distress” specifier, to identify patients who have anxiety symptoms but have not been seen to meet the full criteria of Anxiety Disorder. This specifier has also been added to Major Depressive Disorder.

Major Depressive Disorder is largely unchanged except that if at least 3 manic symptoms co-exist it will be tagged “with mixed features.” The interesting thing about this category is that there used to be a “bereavement exclusion” for those grieving a loved one, and it has now been omitted.

Why? Well for one thing, bereavement was for depressive symptoms following a death which lasted less than two months. It’s now recognized that normal grieving can easily last 1 or 2 years. Secondly, it has been noticed that bereavement can precipitate true depression in the vulnerable, just like any other major stressor. There is therefore no reason to rule out bereavement as the exception. They are now considering a possible new disorder called “persistent complex bereavement.” It is listed in “Conditions for Further Study.”

It has also been noted that bereavement related depression usually occurs in families and people with histories of depression already, and is thus genetically influenced.

Lastly, as I mentioned, is the inclusion of the “Anxious Distress” specifier, just a in Bipolar Disorder.

In a week or so I’ll go on to Anxiety Disorders and other categories. My apologies for turning this out so late...apart from other things going on in my life, this is dry stuff to wade through, and it just takes time.

Deborah is the author of Is There Room for Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness, available at Amazon and other major vendors. Visit her web page at, or see her catalog at