The good and bad of new diagnoses


A draft of the next edition of the Diagnostic & Statistical Manual (DSM-V) has been posted to their website and open for comments by users. The website breaks out the changes being considered in categories so it is easy to find your area of interest.Ā  The final edition isn’t expected until 2013.

Diagnostic changes can be a help and a problem at the same time. When DSM IV removed Multiple Personality Disorder in favor of multiple diagnoses for clarifying dissociative symptoms, that helped clinicians be more descriptive of their client’s struggles. In this new proposal, they plan on eliminating Asperger’s Disorder and subsuming a number of diagnoses (Retts, PDD, etc.) into one diagnosis: Autistic Disorder. I would think this would not be helpful as it reduces specificity.

How about this new entry: Temper Dysregulation Disorder with Dysphoria? A new diagnosis for children? I think it may help in that it might hinder the ever popular “bi-polar” label given too quickly to children (and accompanied with serious meds). On the other hand, it probably will make quite a few roll their eyes. The label doesn’t have that ringing medical sound to it. Not that I’m disparaging the symptoms it tends to cover. There are children who mood is so easily dysregulated, whose reaction to frustrations are way over the top. These children tend to be impulsive to boot. Something isn’t right, but what best identifies their struggles; the etiology of their problems?

6 Comments

Filed under christian counseling, Psychology

6 responses to “The good and bad of new diagnoses

  1. Thanks for your article. Labels have important implications in the DSM because it is what gets reimbursed by insurance, and what institutions base their treatment. I don’t know what the right labels are, yet great caution must be taken.

    Dean

  2. D. Stevenson

    Temper Dysregulation Disorder with Dysphoria
    Didn’t that used to be called spoiled brat? šŸ˜‰

    Seriously though. It is frustrating to have to find a category to put someone just so the insurance company will agree to pay for them to get help. Even if the DSM were an accurate compilation of current knowledge and absent all the politics, there are still people with significant difficulties that won’t squeeze into an existing category.

    It is too bad the insurance company won’t pay us to help the child with the symptoms of “Temper Dysregulation Disorder with Dysphoria” unless the accepted authorities categorize and name it.

    Yeah, I know we all have to be on the same page for research and treatment and all that and I agree.

    I like what I heard Peter E. Tanguay say that he and others who were on DSM-IV committees suggest. As research continues and enough knowledge accumulates, post updates on the APA site. No need for totally new publications. Ha-ha, like that would ever happen. As Dr. Tanguay said…, that will never happen. The APA doesn’t make any money that way.

  3. Yes, it is frustrating. While there are a very few insurance companies that will allow 5-8 sessions before a diagnosis, those days are gone.

    I will say that we psychologists deserve this to some degree. Back in the 80s, it was still common practice to abuse the diagnostic system and treat someone with psychotic symptoms for years under the guise of an “adjustment” disorder. Back then therapists had all the power and the insurance company just had to pay. Sadly, the pendulum has now swung too far the other way.

  4. Hey, Phil!
    I was just looking over highlights of the new DSM draft last week and I found myself going first to the discussion on Bi-polar.
    The difficulty seems to be that there is an intense emotionality that may look like ADHD, Borderline Personality Disorder, Oppositional Defiant Disorder, OCPD, Intermittent Explosive Disorder, Partner Relational Problem, Parent Child Relational Problem, etc., and a mood stabilizer seems to help sometimes.
    Does that mean they were really bipolar and have the same sort or prognosis as bipolar? I want to be able to offer a helpful diagnosis to the client or parents… and to the psychiatrist.
    I guess I am more concerned about the consequences of the diagnosis than the consequences of the serious medication. (maybe because I’m not the one prescribing šŸ™‚ ) The medication can be tried in various doses and even discontinued. The diagnosis of bipolar is less forgiving. It’s a bell that may keep ringing for a long time. I’ve also found that the threat of the diagnosis keeps some from being willing to try the medication. Maybe more options like “Temper Dysregulation Disorder with Dysphoria” would be helpful.
    Thanks for the post.

    • David! Nice to hear from you!

      I’m in complete agreement. Bi-polar labels seem to carry a whole lot more meaning and weight that do many other diagnoses. I’ve seen too many who accept the stereotypes about the label and thus give up trying, especially kids with the label.

  5. harrysnewhamm

    You tube has video titled “autism spectrum seems out of control” and “autism epidemic out of control” that may be of interest here. Looks like the next DSM has a lot to think about, as in what autism is. And is not. Recall the amanda baggs controversy? Google it. Dsm 5 will be an embarrassment to the American Psychiatric Association if they toss Aspergers into the convenient “autism spectrum disorder” since it will show the APA doesn’t know what autism or aspergers is.

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