Tag Archives: DSM

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.  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?


Filed under christian counseling, Psychology

Psychiatric labeling: The problem isn’t the label

Christians tend to have some strong feelings about counseling, psychology, psychiatry and similar terms. Come to think of it, most people, regardless of faith, have strong feelings about these topics. Experiences dictate much of these reactions. Experiences, such as:

  • experiencing or hearing of a mental health representative (mhp) belittling Christianity
  • experiencing or hearing of an arrogant, controlling, or completely incompetent mhp
  • experiencing or hearing of a positive experience where someone found relief or change or insight
  • feeling either helped or stigmatized by a received diagnosis or a use of medication

In psychopathology class tonight, we will explore the background behind psychiatric classifications. How did we get the Diagnostic and Statistical Manual? What are its underpinnings? There are a couple of common concerns about the DSM

  • It purports to be atheoretical and descriptive only
  • Diagnoses suggest objective and distinct “things”
  • It medicalizes problems in living
  • Under one diagnosis (e.g., depression) you can have such wide variety of symptoms
  • Therapists have sizeable disagreements on diagnoses so are they all that helpful?
  • It is leveraged by insurance in ways that make it a liability
  • It doesn’t address matters of the heart or spirit
  • It has political overtones
  • It treats most problems in an individualistic fashion without account for family systems

Every one of these concerns has merit. However, the biggest problem I have is not with the DSM itself but with many of its users. The complaints that are raised about the DSM usually come from someone mis-using the DSM.

Remember the simple explanation of a problem almost always distorts it. Thus, the simplistic use of diagnostic labels almost always does damage.


Filed under counseling, counseling science, History of Psychology, Psychology