This new trend outraged a large segment of the psychiatric community. Most of the so-called bipolar kids—some of whom subsequently took mood stabilizers and antipsychotics with serious side effects—did not have a form of bipolar disorder, many psychiatrists argued. They probably had a different illness altogether. Instead of vacillating between mania and depression, they were irritable most of the time and often erupted in fits of rage and physical violence incommensurate to whatever supposed offense set them off. So the APA decided to create a brand new diagnosis to accommodate these misunderstood children: disruptive mood dysregulation disorder. To meet the criteria, a child between six and 18 must "exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year."
Critics such as Stuart Kaplan of the Penn State College of Medicine, clinical social worker and pharmacist Joe Wegmann, and Allen Frances, professor emeritus at Duke University and chairman of the DSM-IV Task Force, worry that psychiatrists will confuse temper tantrums for a mental disorder and thus continue what they see as a trend of overdiagnosis and overmedication. David Axelson of the University of Pittsburgh put the DSM-5 disruptive mood dysregulation criteria to the test using several years' worth of data collected from 706 children and concluded that the new disorder was not very useful. First, it confusingly overlapped with—and was often difficult to distinguish from—two established diagnoses: oppositional defiant disorder and conduct disorder. Furthermore, a diagnosis of disruptive mood dysregulation in childhood was not a good predictor of future mental health issues, specifically depression and anxiety. Many observers hoped that this research, published in late 2012, would change the APA's mind, but the committee decided to keep disruptive mood dysregulation disorder in the DSM-5.
The personality disorders chapter remains disordered
For decades psychiatrists within and without the APA have called for a complete overhaul of the way clinicians describe and diagnose personality disorders because of obvious flaws. For one thing, many criteria for the 10 personality disorders listed in the DSM overlapped, resulting in so many patients with multiple diagnoses that the validity of certain disorders came into question: Did some of these disorders simply not exist outside the pages of the DSM? Histrionic and narcissistic personality disorders, for example, are both characterized by a need to be the center of attention, a willingness to take advantage of families and friends, and difficulty reading other people's emotions. Additionally, psychiatrists began to rely too heavily on “Personality Disorder–Not Otherwise Specified,” suggesting that some patients had personality problems that were not adequately defined by the DSM in the first place.
More fundamentally, clinical psychologists have increasingly come to realize that people do not categorically have or not have certain problematic personality traits—rather, these characteristics vary in strength from person to person. Therefore, instead of making a diagnosis by looking for the presence or absence of maladaptive personality traits, clinicians should measure the severity of such traits to help determine, in the context of a patient's overall mental health, whether and how the person should be treated.
Although the members of the DSM-5 work group tasked with redefining personality disorders did not agree about everything—and two members, Roel Verheul and John Livesley, resigned in frustration—the team drafted a relatively well-received proposal for serious revisions. The proposal eliminated four redundant disorders and, overall, adopted a much more nuanced view of personality than espoused by earlier versions of the DSM, encouraging thorough interviews to assess how well an individual maintains a coherent sense of self and how he or she interacts with others, rather than trying to slot someone into one of 10 categories based on a few supposedly telltale symptoms.
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8 Comments
Add CommentI see nothing here addressing Complex Post Traumatic Stress as a disorder or syndrome or recognizing it at all. Did that not make the cut for this latest manual, or just not for this article?
Reply | Report Abuse | Link to thisI suspect that these manuals tend to disregard many disorders, as insurance companies prefer it that way.
Reply | Report Abuse | Link to thisA travesty of scientific evidence
Reply | Report Abuse | Link to thisAPA does not seem too worried about the serious risk of false positives, which may have dire negative consequences such as unsuitable drugs, professional exclusion, social labelling.
Reads like a conspiracy between insurance companies and mental health professionals, in which mess people with serious and curable syndromes may well be missed.
You didn't discuss the changes in the eating disorder criteria that are also rather controversial.
Reply | Report Abuse | Link to thisI suspect that this manual will continue to pathologize normal variants of the human personality, and stigmatize those bearing them. While in school, I tended to fidget and look out the window. Now I'm told that that's a symptom of "attention deficit disorder" for which powerful psychoactive drugs are indicated. Never mind that I maintained a 90+ average throughout. Never mind that our ancestors needed a periodic fix on their surroundings if they expected to be the diner and not the dinner. Never mind that our ancestors made their living running for hours on end and killing large animals with primitive weapons. Nothing in biology makes sense except in the light of evoluton, but that doesn't stop fat pigs behind desks from dispensing psychiatric diagnoses to robust healthy rambuntious kids.
Reply | Report Abuse | Link to thisI was never good at matching names with faces or interpreting body language. Now I'm told those are symptoms of Asperger's Syndrome; never mind that I compensate very well with written and spoken language and I do not consider myself sick.
Hardly a day passes when I do not think of President Kennedy. This does not affect my functioning in the least, except on November 22, the anniversary of his assassination, when I am not in the mood for entertainment or Thanksgiving dinner. Now I'm told I have "complicated grief," but all I experience is natural grief for a political idol the like of whom I do not expect to see again in my lifetime.
All this is giving me (complicated?) grief, and calls to mind the abuse of psychiatry by the Soviets to quell political dissent. If you have a biochemical, brain imaging or other definitive test for your diagnosis - fine. Otherwise, throw away the cookie cutter and celebrate humanity's pizzazz.
Geez! Another bestseller for APA. More money folks.
Reply | Report Abuse | Link to thisUnfortunately, commentors are not familiar with the body of work done on DSM, not to mention the study required to become conversant with psychology.
Reply | Report Abuse | Link to thisTo address only a couple misunderstandings:
DSM is a large manual, far beyond the 7 extremely short pages of this article.
Unedited internet comments on subjects which take decades of study to develop coherent understanding are particularly inappropriate.
Although I've studied psychology and related disciplines for sometime, I did not do so for therapeutic reasons. That said, almost no comment on the subject on this or other websites takes into account the real empathy which those involved in the therapeutic disciplines and the development of DSM, as well, have for others, ALL others.
SA is not a panacea site such as MSN Health or any site in which glib curealls are offered for illness or personal difficulties or desires. It is a digest of information which might be used as portal to specific peer-reviewed literature for those who seek knowledge of rigorous research encompassing the lifetimes of hundreds of thousands of dedicated individuals.
I am framing my criticism in terms of a social problem: failure of many in society to respect others, and promoting this disrespect of individuals, groups, and disciplines of professional dedication (ANY discipline, whether within their own culture or outside of it), through using internet comment as aggressive outlet for personal frustration elsewhere.
Commentors might look more insightuflly into their own motivations before attacking others.
How about G.A.S. ? Guitar Acquisition Syndrome? http://www.steelydan.com/gas.html
Reply | Report Abuse | Link to thisLuckily I've recovered. Sadly many haven't.