The diagnostic deluge.

Mental health professionals directing efforts to produce a new guide to mental disorders, set for release next year, find themselves trying to stem a tide of suggested diagnoses that threaten to add substantially to the 292 disorders already included in the current manual. In the last two years, 94 proposed new diagnostic categories have surfaced, report Harold A. Pincus, deputy director of the American Psychiatric Association in Washington, D.C., and his colleagues.

New categories should enter the guide, known as the Diagnostic and Statistical Manual of Mental Disorders (DSM), only if existing research convincingly documents their usefulness in identifying and treating patients, Pincus and his coauthors contend in the January AMERICAN JOURNAL OF PSYCHIATRY. Some clinicians and researchers think that too many new and revamped diagnoses cluttered the last two editions of DSM, published in 1980 and 1987 (SN: 2/25/89, p.120). It usually proves more difficult to evict old diagnoses than to welcome new ones into the DSM fold, Pincus' group says.

Some diagnoses now applied to children -- including identity disorder, overanxious disorder and avoidant disorder -- probably will not make DSM's final cut, the authors say. In addition, scant evidence supports the inclusion of "sadistic personality disorder," they assert. Critics charge that this diagnosis, proposed several years ago, would offer a psychiatric excuse for rapists and spouse abusers.

In contrast, recent research makes likely the acceptance of "acute stress disorder," according to Pincus' group. Acute stress disorder -- less severe than post-traumatic stress disorder -- refers to temporary psychological symptoms following extreme distress or physical risk (SN: 5/25/91, p.333). Ongoing studies indicate that this new diagnosis aids in the treatment of disaster survivors, the authors contend.