by Tobias S. Piering and Andrew Moriarty
What do menstrual cramps, temper tantrums, and getting old have in common? They’re all symptoms of new mental health disorders recognized in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)―a controversial but widely used authority on mental health diagnoses.
New disorders
Published by the American Psychiatric Association (APA), the recently released DSM-5 adds 15 new diagnoses, including hoarding and cannabis withdrawal, while eliminating and combining other disorders. It is the authority on mental health diagnoses for healthcare workers, researchers, the psychiatric community, and insurance companies. The additions and changes come with significant controversy and debate. At the heart of the debate are a number of new disorders, including:
- Social (pragmatic) communication disorder is a “persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability” and will “more accurately [describe] individuals who have significant problems using verbal and nonverbal communication for social purposes.” Symptoms include “problems with inappropriate responses in conversation.”
- Premenstrual dysphoric disorder describes extreme premenstrual syndrome symptoms experienced before most menstrual cycles in a 12-month period. Symptoms include depression, “feelings of hopelessness,” and bloating sensations at specific times during a woman’s menstrual cycle. Symptoms can be severe enough to interfere with a woman’s ability to function at work or school.
- Mild neurocognitive disorder is a disorder that “goes beyond normal issues of aging” and “describes a level of cognitive decline that requires . . . strategies and accommodations to help maintain independence and perform activities of daily living.”
Additionally, the DSM-5 has identified a potentially new disorder warranting additional research before it can be formally included in the DSM: Internet gaming disorder. According to the APA, people with the condition “endanger their academic or job functioning because of the amount of time they spend playing” and “experience symptoms of withdrawal when kept from gaming.” It is, however, limited to gaming and does not include Internet use or gambling. There’s no word yet on whether old- school paper-and-pencil gamers will have a seat at the table when the diagnosis comes around for discussion, but Social (pragmatic) communication disorder may be available as a fallback for those who qualify.
What it means for you
The new mental disorders, along with other revisions, have significant implications for the workplace and pose new challenges for employers. The new version of the manual threatens to make the already complex task of complying with the Americans with Disabilities Act (ADA) more difficult by forcing employers to determine whether and how to accommodate the newly recognized mental conditions in the wake of the 2008 amendments to the ADA that made it easier to show that an ailment qualifies as a disability.
Moreover, under the WLAD’s definition of disability―any sensory, mental, or physical impairment that is medically cognizable or diagnosable―the DSM-5’s recent additions will certainly require employers to consider accommodations under the law. Take, for example, social communication disorder. By recognizing “problems with inappropriate responses in conversation” as a symptom of a mental disorder, the DSM-5 (coupled with some unfortunate language in state and federal appellate court opinions in disability cases) might lead to requests that employers tolerate a measure of rudeness and unprofessionalism that they would never accept from an employee whose social awkwardness had not been the subject of a “diagnosis.”
So what can you do if confronted with one of these new potential “disabilities” ? The same things you’ve always done. For example, remember that the employee must still show a nexus between his disability and his need for accommodation. Ask for medical documentation. Communicate clear and comprehensive job duties and performance expectations, emphasizing that professional conduct is an essential requirement of the jobs at your company. Engage in a thorough interactive process. And for the hard cases, seek legal advice on when enough is enough.
Also, it’s not all bad news for hard-working employers and HR professionals. Caffeine withdrawal―related to the potential addictive behavior caused by excessive, sustained consumption of the stimulant―is recognized by the DSM-5 as a mental health disorder. So think of your caramel macchiato as a preventive accommodation compliments of the DSM-5. Cheers!
Toby Piering is an associate in Perkins Coie’s labor & employment practice group in Seattle, Washington. He can be reached at 206-359-3498 or tpiering@perkinscoie.com.
Andrew Moriarty is a partner in Perkins Coie’s labor & employment practice group in Seattle, Washington. He can be reached at 206-359-3598 or amoriarty@perkinscoie.com.