The psychiatric field has grown by leaps and bounds since the last update to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) came out in 1994. Since then, the widespread use of magnetic imaging and genetic testing has identified brain features previously unknown, which helps to explain the mysteries which psychiatrists and psychologists have been trying to tackle for over a century.
One of the most radical changes, considered as fundamental as the dropping of homosexuality as a mental disorder in 1973, is the removal of transgender from the list of mental disorders. Instead, transgender now falls under a new category, “Gender Dysphoria,” which more accurately describes the emotional distress that is many times experienced by a transgendered person. This may seem minor, but for transgendered people, this can mean a huge difference in their lives. Under the old diagnosis, a transgendered person was often discriminated against at the workplace, had their diagnosis used to take away their children, could be labelled as delusional or mentally ill, even arrested.
Those on the autism spectrum are facing an even more dramatic shift as better understanding of the disorder has resulted in a narrower, clearer definition of the condition. Under the older diagnosis, a person with autism could be labelled as autistic, having Asperger’s, or Pervasive Developmental Disorder – Not Otherwise Specified. Now they are all being put under the term “Autism Spectrum Disorder,” or ASD, with clearly defined areas underneath. The new category now opens up treatment options for adults who may have had a milder or “high functioning” form of ASD and were not correctly diagnosed in childhood. The new category enables people to get the help they need, as it is now fully understood to not be solely a childhood disorder, but one found throughout life. The clearer guidelines also will help prevent misdiagnosis–such as when another condition such as ADHD, ODD or Tourette’s is sometimes applied to someone on the autistic spectrum–enabling people to get the proper treatment as well.
Substance abuse and substance dependence are now being merged into a single category of “Substance use disorder.” This is a common sense solution, as the two conditions blended and the line was very blurry between one to the other. The new definition enables the diagnosing doctor to look at a wider spectrum, in order to gain a more accurate picture of the addiction. This will enable a more concise treatment plan to be developed for those suffering from addictions. With the heavy link between substance disorders and the U.S. prison population, this is a step forward for treatment of the addicted.
One of the more surprising elements is that the condition known as hoarding (the collecting of things to excess) is now listed as a disorder on its own. Over the years, psychologists have found that including it under the obsessive compulsive disorder did not work, as the issue was far different from someone with traditional OCD. Hoarding is now being treated as a more severe issue, as the impact on people’s lives can be devastating.
Post Traumatic Stress Disorder is now being added to the chapter on “Trauma- and Stressor-Related Disorders”, and new information on the effects of PTSD on adolescents and children has been included. Research over the past 20 years on PTSD has resulted in a far better understanding of the impact trauma has on the brain. The physical changes to the human brain, now mapped out, made PTSD a far better understood disorder than it was even 10 years ago. For those of us with friends or family with PTSD, this may help bring them a sense of normalcy again.
The world of psychology is often misunderstood. When someone has a mental disorder, you know what is told to them by well-meaning, but not understanding people: “It’s all in your head.” “Just perk up.” “Get over it.” Physical differences in the brains of people with mental disorders is not something so easily brushed off, and the improvements in diagnostics as well as treatments for those with mental disorders is bringing new hope and new life to those who only 50 years ago might have spent their entire lives in an institution, or worse.