TODAY   |  May 17, 2013

Mental health guide gets first update in 19 years


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>>> something else a lot of people should be interested in, the american psychiatric association 's revisions to its manual of mental disorders , big changes that are already causing some controversy. it is the first time in 19 years that the manual has been updated. according to the task force chair, "our work has been aimed at more accurately defining mental disorders that have a real impact on people's lives," yet there's been debate in the media about the changes. asperger 's out. it's part of the autism spectrum , bereavement over the death of a spouse can be diagnosed as major depression , hording and binge eating are in as newly defined disorders and severe temper tantrums in kids now being diagnosed as disruptive mood dysregulation disorder. gail saltz and psychiatrist sally satelle, from yale university and author of "brainwashed." ladies good morning to both of you. why should we care about this?

>> it's the update, the newer version but really i don't believe this is going to change dramatically the way people are going to practice because most clinicians understand you need to treat symptoms and not diagnoses.

>> if a condition no longer exists likes a. be s a. pe asperger 's, will they still get that care?

>> they'll get the care, the american academy of child and adolescent psychiatry has a fact sheet that should calm down.

>> they might get more funding because autism, schools give autism more services than they do for asperger 's.

>> the book is not technically even out yet. it's about to come out and yet also already it's the subject of controversy. why?

>> we understand that actually we're going to need to move in the direction in a research way looking at the brain as the source of what's going on. we need to look at the biology and genetics and that will probably be the future of diagnosis, but this is the best that we have right now. so it's the conflict of people understanding that maybe it's not sufficient for the future, but it's the best that we have to work with.

>> i think the plus is because psychiatry is a fraught discipline, people think this is a book that distinguishes normal from abnormal, there are bright lines. this has always been a loose framework for thinking about patients so doctors can talk about them with each other.

>> real quickly things like binge eating , in i changes that will impact people in the diagnosis of binge eating ?

>> yes, now actually there will be a diagnosis where if once a week for a number of months you overeat to a great extent and feel badly about it, you could receive this diagnosis, but the truth is if you're just eating a pint of ice cream and don't feel good about it, it's not causing a big problem you're probably not going to come in for treatment.

>> bereavement after the loss of a loved one, i'm experiencing enormous depression.

>> same thing, if a person comes to a psychiatrist in the wake of a loss, it means they're suffering and they need help. it doesn't matter what we call it. now we call it major depression disorder . before we called it bereavement.

>> that concerns me the most, some people might get medication from some doctors for something that really should be support and care and viewed as bereavement and not as major depression .

>> true, that's always been a problem in psychiatry, too quick to medicate but if we didn't have 15-minute office visits we'd have more time with people.

>> doctors thank you very much.