Elimination disorders: a critical comment on DSM-5 proposals

Area of Science:

• Pediatric Gastroenterology and Urology
• Child and Adolescent Psychiatry

Background:

• Elimination disorders, including enuresis (wetting) and encopresis (soiling), are prevalent in children and adolescents.
• Existing diagnostic criteria (DSM-IV) for these disorders are outdated and do not encompass recent research findings on subtypes, causes, and treatments.

Purpose of the Study:

• To highlight the limitations of current diagnostic systems for childhood elimination disorders.
• To introduce and discuss the relevance of the International Children's Incontinence Society (ICCS) and ROME-III criteria for improved classification.
• To advocate for the integration of these updated criteria into future diagnostic manuals like DSM-5.

Main Methods:

• Review and discussion of established classification systems for pediatric incontinence and functional gastrointestinal disorders.
• Comparative analysis of DSM-IV criteria against newer systems like ICCS and ROME-III.

Main Results:

• Numerous subtypes of elimination disorders with distinct characteristics have been identified, necessitating more refined diagnostic categories.
• The ICCS and ROME-III criteria offer comprehensive frameworks that better capture the complexity of these conditions.

Conclusions:

• The current DSM-IV classification for elimination disorders is inadequate.
• Adoption of the ICCS and ROME-III criteria is recommended for both clinical practice and research.
• Integration into DSM-5 is crucial for advancing the understanding and management of childhood elimination disorders.