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Health & Science

What’s Inside The New Manual For Psychiatry?

Psychiatry will reach a historic milestone tomorrow, with the national release of a new diagnostic manual. It’s the most important book in the field of mental health, determining what types of mental illnesses get diagnosed and perhaps more importantly, whether and how insurance will reimburse for treatment of mental illness.



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The Diagnostic and Statistical Manual of Mental Disorders is usually just called the DSM. It first appeared in 1952 and this will be the fifth revision.

Dr. John Oldham is chief of staff at The Menninger Clinic in Houston, a research-oriented psychiatric hospital.

He is also the immediate past president of the American Psychiatric Association, which writes and publishes the DSM.

“What are the symptoms? What are the signs? That’s what this book is. It’s an attempt to describe — as much as we know, from the best evidence we have — about what the main categories of mental illness or psychiatric disorders are: such as depression, such as schizophrenia, such as bipolar disorder, things we read about in the papers all the time.

The manual was last updated in 1994.

The new version will incorporate the latest research and new discoveries based on brain imaging, genetics and other disciplines.

Some of the changes have already attracted a lot of attention.

For example, autism and Asperger’s were previously thought to be separate disorders, but the DSM-5 now groups them together within a single diagnostic category, Autism Spectrum Disorder.

The new manual also recognizes binge-eating disorder as a distinct illness, separate from bulimia or anorexia.

Rebecca Wagner manages the eating disorders program at Menninger.

“People that have a binge episode will sometimes eat between two, three or four thousand calories in 30 minutes to an hour. That’s at least twice or more the amount of food that most people should consume in an entire day.”

So what makes it different from simple pigging out? Wagner says binge eaters do it frequently and suffer great mental turmoil that interferes with their lives.

“It can lead into depression, anxiety, social isolation, it interferes with their ability to engage with other people in relationships. It ends up affecting their job performance, and so it creates this global distress in their life. They don’t want to do this, they recognize that their behavior is abnormal.”

Wagner says now that binge eating has a bona fide diagnosis, it will be easier to bill insurance companies for treatment, and there may be more funding for research.

She also praises the DSM-5 for explaining how eating disorders vary across cultures, and for emphasizing that those with eating disorders have an extremely high risk for suicide.


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