Mental illness terms to change

An effort that promises to broaden the definitions of mental illnesses is spurring a revolt among health care professionals in the United States and England.

A panel appointed by the American Psychiatric Association is proposing changes to the industry's guide for mental illnesses, which determines how patients are diagnosed and treated, and whether insurers pay for care. The new edition of the Diagnostic and Statistical Manual of Mental Disorders is scheduled to be published next year.

The draft is sparking a backlash among practitioners concerned the expanding mandate will increase the number of patients treated with drugs. The guide would loosen diagnostic criteria on some existing ailments and brand as mental disorders some common behaviors, including having temper tantrums three times a week or a lack of sexual arousal. The changes may spur unneeded and dangerous treatment of the healthy, said Allen Frances, a psychiatrist who helped write the current guidelines.

"Everyday disappointments, sufferings and eccentricities are being redefined as psychiatric disorders, and that could lead to medication treatment," said Frances, a professor emeritus at Duke University who lives in San Diego. "This is expanding the boundaries of psychiatry."

In many cases, family doctors will use the new definitions to treat patients, Frances said. Pressure from drugmakers to use medications and television shows that depict ailments could combine to create "an epidemic," he said. "Once primary care doctors and patients have the idea that they saw a certain condition on TV, it becomes real."

Darrel Regier, the psychiatric group's research director, said critics are unconvinced medical treatment is better than counseling. The idea of "medicalizing normality comes from a perspective that there are no psychiatric disorders, and you need to avoid stigmatizing people by giving them one," he said.

An October letter critical of the changes, sponsored by the American Psychological Association in Washington, D.C., was signed by more than 10,800 people, including psychologists, psychiatrists, counselors and community activists.