This past weekend, the fate of the Diagnostic and Statistical Manual, which is considered to be the bible of psychiatry, will be discussed by academics working to publish the controversial fifth edition of the manual. The Diagnostic and Statistical Manual defines every mental disorder and also determines treatments for those disorders. It is updated every 15 years and serves as a standard reference for psychiatrists, insurance companies, drug researchers, the courts and even schools.

Because of this, the fate of literally millions of patients is in the hands of 20 academics from across the county deciding upon the definitions and treatments of these mental disorders. Every time the Diagnostic and Statistical Manual is revised, there are criticisms of the definitions being either too broad or too narrow, but this revised edition is considered the most controversial of them all.

Several days ago, Alex Spiegel, correspondent for NPR’s Science Desk who covers psychology, published an article titled, “Weekend Vote Will Bring Controversial Changes to Psychiatrists’ Bible.” In this article, she discussed several critical changes being discussed for the publication of the new edition. Some of these proposed revisions include the eradication of Asperger’s Syndrome, the addition of the a new childhood disorder called disruptive mood dysregulation disorder, and a new way to think about grief after the death of a loved one.

Although no absolute decisions have been made public yet, there are specific speculations that have been made based on changes the Diagnostic and Statistical Manual published on its website last year.

The eradication of Asperger’s Syndrome is strongly opposed by many people who are currently diagnosed with Asperger’s because instead of being diagnosed with Asperger’s, it is likely that these people will now be diagnosed with mild autism. This broadening of the definition will eliminate specific syndromes and move people into a certain category on the autism spectrum. This proposed change is controversial because many of those people with Asperger’s see it as part of their identity; however, critics who support this change argue that too many people have been diagnosed with Asperger’s.

The second controversial change actually seeks to narrow the definition of bipolar disorder. The new childhood mental disorder, disruptive mood dysregulation disorder, is a new diagnosis created in an effort to decrease the number of children diagnosed with bipolar disorder. This change has been prompted by too many children being treated with anti-psychotic drugs for bipolar disorder. Psychiatrists hope that fewer children will be treated with these medications.

The last heated controversy being discussed is the way psychiatrists view and treat grief after the death of a loved one. In the last addition of the manual, psychiatrists were concerned about diagnosing people with depression after they had lost a loved one. This seems reasonable. After all, grief and sadness are a natural response to death. However, some were also concerned about excluding bereaved people who were actually depressed, not simply grieving naturally. This concern about maintaining boundaries when diagnosing mental disorders that are actually normal human experiences is valid because many critics are concerned that revisions to the Diagnostic and Statistical Manual are trending towards overdiagnosing patients.

For example, Spiegel said that, “This is a small change, but to critics, emblematic of a much larger and more sinister problem: the expansion of behaviors considered abnormal. Shyness becomes “social phobia.” Restlessness becomes ADHD.”

According to the Diagnostic and Statistical Manual’s website, the fifth edition is scheduled for release in May 2013. So, it will be a while before we see whether these controversies are valid concerns or not. Though some of these changes may seem small or even unnecessary, they have huge impacts on people’s insurance policies, medications and treatments, and even access to special education resources offered in schools.

It is important to remember that some of these diagnoses are ever-changing, and they are largely based on observations and speculations from psychiatrists across the country. Yet, these decisions are significant. How we define and treat mental illnesses has huge personal and social implications.