How the Workforce is Impacted by the APA Expansion of Mental Disorders
The American Psychiatric Association (“APA”) recently published the fifth version of its Diagnostic and Statistical Manual of Mental Disorders (“DSM-5”). It includes several diagnostic categories not included in prior editions, which means more employees may qualify for protection under the Americans with Disabilities Act (“ADA”) or the Fair Employment and Housing Act (“FEHA”). While a disorder may not rise to the level of a disability, discrimination protection laws are very broad and include a wide array of conditions. Moreover, according to the Center for Disease Control and Prevention, about 50 million Americans, or 1 in 5 people, are living with at least one disability. Thus, the APA’s expansion of mental disorders could dramatically impact employers and the workforce.
Under California law, “mental disability” includes “having any mental or psychological disorder or condition, such as … emotional or mental illness … that limits a major life activity.” Because of the expansive definition of a protected disability, any mental impairment may qualify as a protected disability. Employers must be prepared to recognize situations that might trigger their reasonable accommodation obligations.
In DMS-IV, there was an exclusion for a major depressive episode that applied to depressive symptoms lasting less than two months following the death of a loved one (the “bereavement exclusion”). This exclusion was removed from DSM-5 for a variety of reasons including the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one, and commonly lasts one to two years. While most people who experience the loss of a loved one experience bereavement without developing a major depressive episode, employers need to be aware that their bereavement leave policies may not accommodate an employee who needs additional time off.
New obsessive-compulsive disorders in the DSM-5 include hoarding disorder, excoriation (skin picking), substance/medication-induced obsessive-compulsive disorder, body dysmorphic disorder (includes repetitive behavior or mental acts in response to preoccupations with perceived defects or flaws in one’s physical appearance); and body-focused repetitive disorder is recurrent behaviors such as nail biting, lip biting and cheek chewing.
The DSM-5 also contains several new depressive disorders, including premenstrual dysphoric disorder (“PMDD”). PMDD is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation, which are more severe than those seen with premenstrual syndrome (“PMS”). Whereas the symptoms of PMS may be troubling and unpleasant, PMDD may cause severe, debilitating symptoms that interfere with a woman’s ability to function. It is estimated that as high as 13-18% of women of reproductive age may have PMDD symptoms severe enough to induce impairment and distress.