In the U.S., the term “unofficial” mental disorder is generally used to describe any condition not recognized by the American Psychiatric Association (APA) and included in an APA guidebook called the Diagnostic and Statistical Manual of Mental Disorders. As a rule, disorders are excluded from this guidebook if they don’t meet the standards of the committees of specialists working within the APA. However, some unofficial disorders appear in a part of the Diagnostic and Statistical Manual—called Section III—dedicated to identifying potentially valid conditions that merit further investigation by mental health researchers.
The American Psychiatric Association is the primary professional organization in the U.S. for doctors who finish basic medical school and then go on to complete the specialized training required to work as a practicing psychiatrist. This organization started publishing the Diagnostic and Statistical Manual (DSM) in the 1950s in an attempt to provide working psychiatrists with standard criteria they could use to diagnose the mental health issues regularly presented by their patients. Over time and through numerous new editions and partial revisions, the manual has become the primary reference for psychiatrists and other mental health professionals. The “official” nature of the definitions contained in the DSM comes from the guide’s long-standing history, prominence and comprehensive coverage of mental health issues, not from any governmental body or agency. In order to gain entry into the Diagnostic and Statistical Manual, a proposed disorder must meet the scrutiny of an American Psychiatric Association committee called a work group. Each of these groups maintained by the APA includes psychiatrists who specialize in the conditions reviewed by that group. In addition to their own professional experiences, the members of any given work group base their decisions on the most recent verifiable information gathered through scientific research, as well as on information gathered from the doctors who use the DSM on a daily basis. The content of the newest edition of the Diagnostic and Statistical Manual changes whenever the American Psychiatric Association as a whole approves any additions, deletions or alterations recommended by the standing work groups.
Understanding Section III
Sometimes, APA work groups reject proposed mental health disorders outright and decline to include them in the Diagnostic and Statistical Manual. Generally speaking, this happens if the proposed definition for a disorder does not identify a unique mental health problem, doesn’t set realistic criteria that doctors can use to diagnose a unique mental health problem, and/or doesn’t have enough verifiable scientific support from the research community. “Unofficial” disorders rejected by the American Psychiatric Association may still be discussed by the general public or mental health experts, but for a number of reasons, doctors rarely diagnose these conditions as part of their regular practice. Section III serves several different functions in the fifth edition of the Diagnostic and Statistical Manual (DSM 5). One of its primary functions is to allow the American Psychiatric Association to identify “unofficial” mental disorders that don’t meet the standard for inclusion into the main body of the DSM, but still come close enough to that standard to avoid rejection as a mental health concept. In some cases, the APA eventually gives full recognition to the unofficial conditions contained in any given edition of the Diagnostic and Statistical Manual. In other cases, conditions identified for further consideration in one edition of the manual eventually get rejected and don’t appear in the DSM again.
As of 2013, the conditions currently listed in Section III of the Diagnostic and Statistical Manual are nonsuicidal self-injury, caffeine use disorder, Internet gaming disorder, attenuated psychosis syndrome, suicidal behavior disorder, persistent complex bereavement disorder, a condition called depressive episodes with short-duration hypomania, and a condition called neurobehavioral disorder associated with prenatal alcohol exposure. The most prominent example of a formerly “unofficial” condition that now appears in the main body of DSM 5 is the eating disorder called binge-eating disorder. This condition bears some similarity to the eating disorder called bulimia nervosa, but has distinct features that mark it as a separate mental health concern. The American Psychological Association specifically states that one of its motivations for placing certain unofficial conditions in Section III is a desire to encourage the funding and concentrated research efforts required to further the accumulation of knowledge regarding important, unresolved mental health issues. Without this encouragement, it’s possible that many vital avenues of research would go unexplored in the foreseeable future.