A proposed new edition of the handbook which helps American psychiatrists decide someone is mentally ill has potential implications for New Zealand, where many mental health experts use the manual as a reference.
The proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) could mean many presently healthy people suddenly are capable of being classified as having a mental illness, according to a New Zealand researcher, Professor Graham Mellsop, of the clinical school at Waikato University.

"It extends the risk of medicalising what are essentially parts of people's normal lives, and part of the spectrum of ordinary human ways of living," he said in a personal comment. Behaviours such as binge-eating or hypersexuality -- recurrent and intense sexual fantasies -- may become classified as mental illnesses.

Published by the American Psychiatric Association (APA), the handbook is commonly referred to as the "psychiatrists' bible", and Prof Mellsop -- who has studied the extent to which NZ psychiatrists rely on its definitions -- said it is influential not just in the United States, but also New Zealand, Canada, and Australia. And the influence is not confined to the medical sector. A defence lawyer in the case where Sophie Elliott was stabbed to death claimed the man convicted of the crime, Clayton Robert Weatherston, had a personality disorder which included narcissism meeting the DSM definition, and that it was a mitigating factor.

Courts sometimes felt a "misplaced comfort" in hearing a diagnosis according to the existing manual, DSM-IV, which was not necessarily a helpful thing.

The proposed new edition, DSM-V, is open for public comment until April 20. It comes up with some exotic-sounding conditions, including negativistic personality disorder for people who whinge constantly and intermitten explosive disorder for people prone to adult tantrums.
"Good psychiatrists will very much keep the DSM-IV or DSM-V labels in perspective," said Prof Mellsop. "A good psychiatrist will be taking account of a very wide range of the aspects of the person's presentation and their needs, and doing the clinical management in the context of those, and not particularly relying on the diagnosis".

In America, having an illness listed in the DSM made it possible for psychiatrists to be funded to provide treatments for those conditions.
"It meets the needs of the American health industry," he said. "It's not seen as being a truly valid classificatory system, but it's popular ... in New Zealand". A lot of the textbooks on which NZ doctors were trained were American, but outside North America and Australasia, a different system, the International Classification of Diseases (ICD) manual dominated.

Prof Mellsop said the idea in the next DSM manual of creating a diagnosis called "psychosis risk syndrome" to identify adolescents or young adults at risk for developing serious mental illnesses marked by hallucinations and delusions "goes way beyond what the APA has got sufficient evidence for" he said.

A diagnosis perceived to foreshadow a full-blown psychotic illness risked stigmatising people or exposing them to unnecessary treatment. Scientific trials, with controls, had failed to show the effectiveness of intervening in the lives of people perceived as being at risk of later developing a psychosis.

"If DSM-V comes out with all these silly ideas that have been foreshadowed .. it's going to gradually knock itself off the perch," he said. In the past, the ICD manual had mimicked the DSM, "but I think these proposals are going to cause major rifts between the two".

Credit:NZPA