Mental health experts ask: Will anyone be normal?

An updated edition of a mental health bible for doctors may include diagnoses for “disorders” such as toddler tantrums and binge eating, experts say, and could mean that soon no-one will be classed as normal.

Leading mental health experts gave a briefing on Tuesday to warn that a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is being revised now for publication in 2013, could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.

Citing examples of new additions like “mild anxiety depression”, “psychosis risk syndrome”, and “temper dysregulation disorder”, they said many people previously seen as perfectly healthy could in future be told they are ill.

“It’s leaking into normality. It is shrinking the pool of what is normal to a puddle,” said Til Wykes of the Institute of Psychiatry at Kings College London.

The DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It is seen as the global diagnostic bible for the field of mental health medicine.


The criteria are designed to provide clear definitions for professionals who treat patients with mental disorders, and for researchers and pharmaceutical drug companies seeking to develop new ways of treating them.

Wykes and colleagues Felicity Callard, also of Kings’ Institute of Psychiatry, and Nick Craddock of Cardiff University’s department of psychological medicine and neurology, said many in the psychiatric community are worried that the further the guidelines are expanded, the more likely it will become that nobody will be classed as normal any more.

“Technically, with the classification of so many new disorders, we will all have disorders,” they said in a joint statement. “This may lead to the belief that many more of us ‘need’ drugs to treat our ‘conditions’ — [and] many of these drugs will have unpleasant or dangerous side effects.”

The scientists said “psychosis risk syndrome” diagnosis was particularly worrying, since it could falsely label young people who may only have a small risk of developing an illness.

“It’s a bit like telling 10 people with a common cold that they are “at risk for pneumonia syndrome” when only one is likely to get the disorder,” Wykes told the briefing.

The American Psychiatric Association did not immediately respond to a request for comment.

The scientists gave examples from the previous revision to the DSM, which was called DSM 4 and included broader diagnoses and categories for attention deficit hyperactivity disorder (ADHD), autism and childhood bipolar disorders.

This, they said, had “contributed to three false epidemics” of these conditions, particularly in the United States.

“During the last decade, how many doctors were harangued by worried parents into giving drugs like Ritalin to children who didn’t really need it?,” their statement asked.

Millions of people across the world, many of them children, take ADHD drugs including Novartis’ Ritalin, which is known generically as methylphenidate, and similar drugs such as Shire’s Adderall and Vyvanse. In the United States alone, sales of these drugs was about $4,8-billion in 2008.

Wykes and Callard published a comment in The Journal of Mental Health expressing their concern about the upcoming DSM revision and highlighting another 10 or more papers in the same journal from other scientists who were also worried. DSM 5 is due to be published in May 2013. – Reuters

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