The Psychiatric Bible: Manual Manipulation

The Diagnostic and Statistical Manual of Mental Disorders provides mental health professionals with a guide for diagnosing psychological problems, and insurance companies with a touchstone for determining reimbursement. The 5th edition, due out in 2012, promises a new set of diagnoses and a reorganization of existing ones. Some will even be eliminated.

Disorders that might go in:

Behavioral Addiction

The Definition: Excessive use of sex, shopping, or computers may signal addiction. These behaviors can be taken to such extremes that they easily mimic the behaviors of drug addicts.

The Debate: People with behavioral addictions share signs of drug addiction, including uncontrolled use, tolerance, and withdrawal. But these supposed disorders may actually indicate underlying obsessive-compulsion or depression.

Binge Eating Disorder

The Definition: Individuals who binge are unable to control periods of overeating and feel guilty or disgusted with themselves. They often become obese. Some eat alone to avoid feelings of shame.

The Debate: While many suggest that this diagnosis imparts information about prognosis and treatment that is more precise than disorders already in the DSM, some argue that binge eating is often a product of depression or anxiety.

Complicated Grief

The Definition: After the death of someone close, grief and sadness normally begin to dissipate within six months. But some people continue to mourn for much longer.

The Debate: Although there is a rising tide of support for classifying it as a disorder, skeptics wonder whether there is enough evidence to show that the diagnosis is not simply a form of depression or PTSD.

Disorders that might get the boot:

The Paraphilias

The Definition: Intense sexual urges involving animals, children, nonconsensual sex, suffering, or humiliation are classified as paraphilias—a term that was thought to be relatively nonjudgmental when it replaced "perversions" in 1980.

The Debate: The category marks individuals as deviant and strange, even if they can live well-adjusted lives, according to critics. Others argue that paraphilias are dysfunctional, as they interfere with a person's sociability and sexuality. In a nod to the politics that infiltrate the DSM, Robert Spitzer, a psychiatrist, points out that removing pedophilia would be "a public relations disaster."

Gender Identity Disorder

The Definition: Since the DSM-III appeared in 1980, individuals who wish to be of the opposite sex—and who are uncomfortable with their own—have been diagnosed with Gender Identity Disorder.

The Debate: As the transgender community has become better established, some members—and some psychiatrists—gripe about the stigmatization surrounding the diagnosis, and point out that transgender individuals can be perfectly happy. If the diagnosis is eliminated, however, insurance companies may file treatment under "cosmetic" and thus refuse to pay for sex reassignment surgery or hormone therapy.

Sources: George Bonanno, PhD; Jack Drescher, MD; Michael First, MD; William E. Narrow, MD; B. Timothy Walsh, MD