Does the concept of attenuated psychosis sound familiar? Perhaps you’ve seen it as a diagnostic proposal for further research in the current DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). It involves attenuated psychotic symptoms that cause distress and interference.

Many people are familiar with the common schizophrenia and delusional disorders. However, some attenuated symptomatology falls short of meeting the criteria for a given psychotic disorder even though it could be the first “step” towards one. Well, this is just what the DSM-5 refers to with this “new” possible diagnosis.

“All are lunatics, but he who can analyze his delusion is called a philosopher.”

-Ambrose Bierce-

Attenuated psychosis syndrome

Attenuated psychosis syndrome is under “Other psychotic disorders” in the DSM-5. Specifically, Section 3 of the DSM-5 contains an appendix of the manual that includes new possible diagnostic categories that are still being evaluated.

This is a risk syndrome for types of psychosis that include teens with symptoms such as thought disorders or sensory-perceptual disturbances.

These youngsters wouldn’t meet the criteria for a diagnosis of a psychotic disorder. However, according to this proposed syndrome, they could develop one in the future.

Definition and description: diagnostic criteria

This isn’t a new official diagnosis, only a proposal to be the subject of further study (APA, 2013). What this means is that it may indeed become a new diagnostic category in the future. But what exactly is attenuated psychotic syndrome?

It includes the following, according to the DSM-5 criteria:

1. Delusions, hallucinations, or disorganized language

There must be at least one of these symptoms (delusions, hallucinations, or disorganized language) in an attenuated form. In addition, the judgment of reality is relatively intact, but the severity or frequency of these symptoms often require clinical attention.

2. Frequency of one time per week

The above symptoms must have occurred with an average frequency of at least once a week for the past month.

3. Onset or worsening

Another criterion of attenuated psychosis syndrome refers to the onset or worsening of symptoms. Thus, these must have started or worsened significantly, in the past year.

4. Discomfort

Psychological distress or discomfort is usually the limit that allows you to diagnose a mental disorder or discard it. In this case, there’s intense discomfort produced by the aforementioned symptoms.

Instead of discomfort, there may be dysfunction or interference in the daily functioning of such intensity that it requires clinical attention. Discomfort may also require it, though.

5. Not explained by other disorders or substances

The syndrome of attenuated psychosis can’t be better explained or accounted for by the presence of another mental disorder. This includes major depressive disorder or bipolar disorder with psychotic characteristics.

Neither can it be attributed to the physiological effects of a substance nor to another medical condition.

6. Attenuated psychosis syndrome isn’t a psychotic disorder

Finally, in order to be diagnosed with this syndrome, it mustn’t meet the diagnostic criteria for any other psychotic disorder. However, it can definitely lead to one of them.

Epidemiology

The prevalence of the syndrome of attenuated psychosis is unknown to date. However, the symptoms described in this disorder aren’t uncommon in the general population.

In fact, these symptoms (specifically hallucinatory experiences and delusional thinking), according to the DSM-5, range from eight to 13 percent. There seems to be a slight preponderance of the syndrome in the male sex.

Onset, course, and comorbidity

When does the disorder appear? Well, the onset is usually in late adolescence or early adulthood. Normal development may or may not precede it.

It may also appear after some evidence of cognitive impairment, negative symptoms of a psychotic disorder (such as anhedonia), or impaired social development.

In certain cases, the syndrome may develop into a depressive or bipolar disorder with psychotic features. However, more often it develops into schizophrenia spectrum disorders.

Pros and cons of listing attenuated psychosis in the DSM-5

Experts who defend this type of proposal point out the therapeutic and prognostic importance, as well as the benefit for the patient. However, certain mental health professionals highlight the risks and prejudices of this new category.

According to them, there are certain risks in its creation, as it doesn’t contain enough scientific criteria for adequate primary prevention of schizophrenia or the rest of the psychoses. Thus, according to Hueso (2011), people diagnosed with this syndrome could be uselessly diagnosed, medicalized, and stigmatized.

Future prospects besides attenuated psychosis

There’s a lot of criticism about the inclusion of so many new diagnoses into the DSM-5. Perhaps this is one of the reasons why the syndrome of attenuated psychosis isn’t yet considered a diagnosis as such, even if it could become one in the future.

Finally, this proposal continues to fuel the debate that’s been going on for many years on the medicalization of everyday life, emotions, and behaviors. Is human pain always susceptible to being a mental disorder? Stick around to see how this “new” syndrome evolves.

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