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Redefining mental disorders to add hoarding and binge eating

There are an estimated 2 million hoarders in America who are so unable to throw things out that their lives, jobs and families can be ruined. Their stories are featured in the TLC series, "Buried Alive." Cindy Carroll, seen here in red, is one of them (Photo courtesy TLC)

A form of autism is out, while binge eating and hoarding are in as recognized mental disorders in the latest version of the “diagnostic bible” psychiatrists use.

For the first time in almost two decades, the nation’s psychiatrists voted to change the guidebook they use to diagnose mental disorders – The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.

Details will come in May when the group’s fifth diagnostic manual is published. Among the changes:

Eliminating Asperger’s, a mild form of autism. Instead Asperger’s symptoms will come under the newly added “autism spectrum disorder,” which is already used widely. That umbrella diagnosis will include children with severe autism, who often do not talk or interact, as well as those with milder forms.

Adding hoarding to the list of mental disorders. Hoarding is a potentially debilitating disorder where people accumulate more and more things in their home – clutter – to the point that they are no longer able to use their house for its intended purpose.

Binge eating will also be considered a mental disorder. Binge eating is a pattern consists of episodes of uncontrollable eating. A person rapidly consumes an excessive amount of food. Most people who have eating binges try to hide this behavior from others, and often feel ashamed about being overweight or depressed about their overeating.

Post-traumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 about trauma and other stress-related disorders. It will reportedly outline the behavioral symptoms that accompany PTSD.

Creating a new disorder classification called dysregulation. That’s something we commonly think of as temper tantrums. The mood disorder would diagnose children with persistent irritability and frequent episodes of behavior outbursts, three or more times a week for more than a year.

Dyslexia and other learning disorders remain. Many with the reading disorder did not want their diagnosis to be dropped, and it won’t be. Instead, the new manual will have a broader learning-disorder category to cover several conditions, including dyslexia, which causes difficulty understanding letters and recognizing written words.

Eliminating the term gender identity disorder. It has been used for people who believe that they were born the wrong gender. Many say the condition isn’t a disorder and that calling it one is stigmatizing. The term would be replaced with “gender dysphoria,” which means emotional distress over one’s gender.

The University of Pittsburgh psychiatry professor who chaired the redefinition committee, Dr. David Kupfer, says the goal was not to expand the number of people diagnosed with mental illness but to ensure those affected were more accurately diagnosed so they could get the most appropriate treatment.

Although there were minor revisions to the psychiatrists’ “bible” in 2000, the last major revision was in 1994.

The manual is important not only for doctors and potential patients, but because the health insurance industry also uses it when deciding which treatments to cover or deny.

By LINDA THOMAS, Later this month I’ll take a closer at the issue of mental illness through the story of a local mother and daughter who were part of an “average family” until two years ago.

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