Psychiatry's authoritative guidebook is about to get shock treatment. The American Psychiatric Association, publisher of the 943-page Diagnostic and Statistical Manual of Mental Disorders, will broaden the definitions of mental illnesses, meaning doctors could prescribe psychotropic drugs to millions more people than before. The struggling healthcare sector and courtrooms could get shocked, too: Insurers-including Medicare and Medicaid-follow the manual's diagnoses to determine who gets coverage. Lawyers refer to them when arguing a criminal defendant is impaired.
When the APA publishes the fifth edition of the manual next year, it will likely include "binge eating disorder" for the first time. Under new addiction definitions, a chronic gambler or someone who craves and drinks alcohol more often than he or she intends could be considered an addict. Some health experts predict the changes will greatly inflate the number of people considered substance abusers, perhaps by 20 million.
Doctors who favor these revisions think the labels will help identify patients who may be on the path to more serious problems. They hope to offer early treatment. But other doctors argue the changes will medicalize normal human behavior.
Responding to pressure, the APA dropped several categories originally proposed, such as "hypersexual disorder" (sex addiction), and tried to alleviate fears that its new definition of depression would include people who experience intense grief for more than two weeks after losing a loved one. Editors added a footnote to the depression entry suggesting a grief response that includes "feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss" is normal.
Other changes remain: More children than before could be diagnosed as having attention-deficit hyperactivity disorder, or-if they throw temper tantrums frequently-having "disruptive mood dysregulation disorder."
An open letter to the APA, signed by over 13,000 health professionals (posted at ipetitions.com/petition/dsm5), claims that by lowering diagnostic thresholds, the manual could trigger "false-positive epidemics"-meaning children and adults who might not need medication may get it anyway.
Chief among critics is Allen Frances, a psychiatric expert who led the task force that revised the current edition of the manual two decades ago. In an op-ed in The New York Times Frances said the new edition would "result in a glut of unnecessary and harmful drug prescription."
A group of psychologists has asked the APA to submit the revised manual to an independent review. Frances goes much further. He wants a governmental body, such as the Department of Health and Human Services, to take charge of mental illness definitions. Psychologists, counselors, social workers, epidemiologists, and legal experts should all have input, Frances said: "Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists."
Secretary of Energy Steven Chu announced last month American and Japanese partners had successfully extracted methane hydrate, a fossil fuel some estimates rank as the most abundant in the world. During a 30-day field test (the longest to date), drillers on Alaska's North Slope pumped carbon dioxide and nitrogen underground and freed methane hydrate molecules-frozen,
crystalline structures composed of natural gas. The Energy Department is investing $6.5 million this year to learn if the resource can be safely and cheaply developed. -Daniel James Devine