• By Dartington SRU
  • Posted on Wednesday 24th February, 2010

Skin picking disorder invites show of hands

In the background of the general effort to improve the lives of all children and their families is an acknowledgment of widespread, intractable, precisely-named affliction.The identification of attention deficit hyperactivity disorder, obsessive-compulsive disorder, Asperger’s syndrome and autism spectrum disorder, for example, and the improving insights into their incidence and prevalence, have helped to shape public health policy.But the changeable definition of individual disorders is itself an aspect of improving science, and one of the most important systematic approaches to that continuous process of classification is in the throes of what software developers might call “a major upgrade”.At the moment, child psychiatrists rely on Mark 4 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) governed by the American Psychiatric Association (APA).In May 2013, DSM-5 is due to be published following a lengthy consultation and review period, which has just reached a pivotal moment with the online publication of new draft disorders and disorder criteria, The Future of Psychiatric Diagnosis.Between now and the end of April, the APA is inviting comment on numerous changes. The proposals range across the highly specific, for example, the case for new entries such as “binge eating disorder”, “skin picking disorder” and “olfactory reference syndrome” (preoccupation with the belief that one emits a foul odor not perceived by others). They also include the arrestingly fundamental: for example a proposed revision of the base definition of a mental disorder.A commentary in the Irish Medical Times points out that what may seem at first acquaintance to be a matter of small adjustment actually has wide implications: more precise definition may open the door to the development of new, improved primary and secondary interventions.The focus of the Irish Medical Times’s coverage is an upsurge in the rate at which children are being assigned the diagnosis of bipolar disorder, which it describes as one of the most dramatic developments in recent child psychiatry.It says the new criteria now under discussion, based on a decade of research on severe mood dysregulation, may help clinicians better differentiate children with these symptoms from those with bipolar disorder or oppositional defiant disorder.Another change it observes – which may also affect the developmental direction of prevention science – is the proposal for a “risk syndromes” category to help identify earlier stages of disorders.“The proposal for a psychosis risk syndrome is still under discussion and the work group hopes to gather significant feedback from the public about this recommendation,” the Times comments. "In explaining the rationale for the move, the APA clearly states that early signs and symptoms of schizophrenia, for example, are present years before diagnosis is established and can be predicted even in infants.”

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