Hoarders beware

Science | Critics say an upcoming manual for psychiatrists suffers from overdiagnosis disorder | Daniel James Devine

Illustration by Krieg Barrie

The bible is about to be rewritten, and many are unhappy about it. But this probably isn't the one you've read: It's the Diagnostic and Statistical Manual of Mental Disorders, or the DSM, an authority for tens of thousands of psychiatrists in the United States and elsewhere. The 943-page guidebook is responsible for defining schizophrenia, post-traumatic stress disorder, ADHD, depression, and every muddled mental state in between. Insurance companies refer to the DSM to write up health coverage, and criminal courts pass sentence with its disorders in view.

Due for release in May 2013, the fifth edition of the DSM—the first major revision since 1994—may overhaul the structure of the book and include new diagnoses like binge eating disorder and psychosis risk syndrome. The manual's publisher, the American Psychiatric Association (APA), has invited public comment on its efforts at improvement, aimed at avoiding misdiagnoses and helping doctors catch the early signs of a disorder. But some psychiatrists think the changes go too far, and will result in an epidemic of "overdiagnosis," where patients receive powerful medications to treat symptoms that may actually be quite common in society.