Shared Psychotic Disorder: Recommended for Removal in DSM 5
In 1952, the American Psychiatric Association devised a revolutionary psychiatric manual, known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The purpose: to assist mental health professionals in establishing accurate and uniform diagnoses for clients. There have been four different volumes of the DSM published, including various revisional editions as deemed necessary by the clinical community. As new mental illness diagnoses criteria are discovered, the DSM must be edited and updated to ensure that clinicians may better serve their patients. (Halgin & Krauss-Whitebourne, 2010, pp. 40-42) In 2000, the APA began working with over 160 clinical experts to develop the latest edition, DSM 5. This work group has the responsibility of including new criteria and removing or re-categorizing certain disorders. They have developed a working draft and the final version of the DSM 5 is expected in May of 2013. (Rubin, 2010) One of the disorders in question is referred to as Shared Psychotic Disorder (SPD); it is currently not being considered for inclusion in the DSM-5.
In the current DSM-IV-TR, Shared Psychotic Disorder is an uncommon disorder that may occur between two or more individuals. People diagnosed with SPD exhibit delusional symptoms that are similar to the delusional symptoms experienced by one or more persons with whom they have a close relationship with. The disorder is sometimes referred to as folie à trois (French for "a madness shared by two"), but has also been documented to occur in groups, specifically, family members. (Sharon, Sharon, Elijah, Shteynman, & Wilkens, 2009) In the current edition of the DSM-IV-TR, Shared Psychotic Disorder can be diagnosed by using three relatively simple sets of criteria as set forth by the American Psychiatric Association (2000):
A. A delusion develops in an individual in the context of a close relationship with another person(s), who has an already established delusion.
B. The delusion is similar in content to that of the person who already has the established delusion.
C. The disturbance is not better accounted for by another Psychotic Disorder (e.g., Schizophrenia) or a Mood Disorder With Psychotic Features and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. (p. 180)
An interesting and rare example of Shared Psychotic Disorder among family members (folie à famille), is a case in which a 44 year-old man was diagnosed with parasitosis, a disorder that can be diagnosed when a person believes they are infested with parasites but there is no medical proof of an infection. This man was examined by a dermatologist and tested for parasites without any conclusive results. Eventually, his medical providers were informed that his wife and daughters also were "infested" with parasites and later learned that his wife, the dominant head of the family, had many delusional thought patterns. She demonstrated much influence over the rest of her family, including the delusional belief that the husband and daughters were all infested with parasites and they, too, began to erroneously believe that they were infected. The members of this family were diagnosed with Shared Psychotic Disorder. (Daniel & Srinivasan, 2004, p. 296-297)
The group of clinical experts working on the new DSM-5 have proposed various re-categorizations and changes to criteria to diagnosis certain disorders. The work group has also decided to remove some disorders from the manual and SPD is presently being recommended for removal from the psychotic disorders section. The rationale behind this decision is that SPD is more commonly associated with other personality disorders and can also share symptoms with other illnesses, such as Obsessive Compulsive Disorder. In addition, there already exists another disorder, referred to as "delusional disorder", which has similar criteria to SPD. Since one of the goals of the DSM revision is to allow for uniform diagnoses, the removal of SPD will better assist with this purpose. (APA DSM-5, 2010)
Albeit Shared Psychotic Disorder has documented cases, when compared to other disorders, it lacks extensive research by the clinical community. A basic search in a medical article database returns limited results in comparison to a more common disorder such as schizophrenia. (APA DSM-5, 2010) Interestingly enough, a simple internet query brings up a larger number of results for the disorder being used as a criminal defense. In one instance, three sisters were able to use SPD as a successful defense for their criminal behavior. (Joshi, Frierson, & Gunter, 2006) Therefore, while the removal of SPD from the DSM-5 may not significantly affect psychologists and psychiatrists, it should be noted, that future criminal defense claims may be adversely affected.
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American Psychiatric Association (Ed.). (2000). Diagnostic and Statistical Manual of Mental Disorders : DSM-IV-TR (Rev. 4th ed.). Washington, D.C.: Author.
APA DSM-5. (2010). Retrieved February 26, 2010, from American Psychiatric Association website: http://www.dsm5.org/
Daniel, E., & Srinivasan, T. N. (2004, September/). Folie a Famille: Delusional parasitosis affecting all the members of a family. Indian Journal of Dermatology, Venereology & Leprology, 70(5), 296-297.
Halgin, R. P., & Krauss-Whitebourne, S. (2010). The Diagnostic and Statistical Manual of Mental Disorders. In Abnormal Psychology (6th ed., pp. 40-42). Boston: McGraw Hill.
Joshi, K., Frierson, R., & Gunter, T. (2006). Shared Psychotic Disorder and Criminal Responsibility: A Review and Case Report of Folie à Trois. Journal of the American Academy of Psychiatry and the Law, 34(4), 511-517. Retrieved from http://www.jaapl.org//////
Rubin, R. (2010, February 11). Updates proposed for psychiatry’s ‘bible’. USA Today.
Sharon, I., Sharon, R., Elijah, J., Shteynman, S., & Wilkens, J. (2009, November 17). Shared Psychotic Disorder. Retrieved February 26, 2010, from Medscape website: http://emedicine.medscape.com//293107-overview
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