In 1994, Asperger's disorder, which is marked by normal intelligence and language abilities but poor social skills, made the DSM-IV. When the DSM-5 is published in 2013, the disorder may get the boot.
The reason? Research on Asperger's and high-functioning autism has failed to find a difference between the two diagnoses. Overlap between the two disorders is rampant (up to 44 percent of kids diagnosed with Asperger's or "other autism spectrum" labels actually met the criteria for high-functioning autism, according to a 2008 survey). If the proposed changes are adopted, people with Asperger's will be reclassified as having high-functioning autism.
But some Asperger's advocates disapprove. The high-functioning autism label doesn't always fit people with Asperger's, said Dania Jekel, the executive director of the Asperger's Association of New England, which opposes the change.
"People with Asperger's are going to be missed," Jekel said.
Childhood bipolar disorder
If diagnosing adults with a childhood disorder is controversial, so is diagnosing children with a disorder once thought to occur mainly in adults. Bipolar disorder, which is characterized by mood swings between depression and excitability, recently skyrocketed as a childhood disorder. Between 1994 and 2003, the number of doctor visits associated with childhood bipolar disorders went up 40-fold, according to a 2007 study in the journal Archives of General Psychiatry.
The problem, according to the APA, is that at least some of that increase is due to changes in the way psychiatrists diagnose bipolar in kids, not an actual increase in cases. To correct the issue, the APA is considering changes to the current bipolar criteria, as well as the addition of a new disorder, temper dysregulation with dysphoria. That disorder would apply to kids with persistent irritable moods and frequent temper tantrums, but has already drawn skepticism from some who believe it pathologizes normal kid behavior.
Attention deficit hyperactivity disorder is a well-known childhood diagnosis. Kids with ADHD have trouble sitting still, paying attention and controlling their impulses. Only recently, however, have psychiatrists begun to diagnose ADHD in adults.
But just as ADHD in children was criticized as over-diagnosed, so is adult ADHD. A common accusation is that psychiatrists are conspiring with pharmaceutical companies to sell more ADHD drugs, writes New York University psychiatrist Norman Sussman in a March 2010 editorial in Psychiatry Weekly. However, adult ADHD is here to stay, Sussma writes: "The benefits of pharmacologic and behavioral therapies are well-established."
Dissociative identity disorder
Once known as multiple personality disorder, dissociative identity disorder was made famous by the book "Sybil" (Independent Pub Group, 1973), which was made into a movie of the same name in 1976. The film and book told the story of Shirley Mason, pseudonym Sybil, who was diagnosed as having 16 separate personalities as a result of physical and sexual abuse by her mother.
The book and the movie were hits, but the diagnosis soon came under fire. In 1995, psychiatrist Herbert Spiegel, who consulted on Mason's case, told the "New York Review of Books" that he believed Mason's "personalities" were created by her therapist, who — perhaps unwittingly — suggested that Mason's different emotional states were distinct personalities with names. Likewise, critics of the dissociative identity diagnosis argue that the disorder is artificial, perpetuated by well-meaning therapists who convince troubled and suggestible patients that their problems are due to multiple personalities.
Nonetheless, dissociative identity disorder has weathered this criticism and won't undergo any major changes in the DSM-5.