In what has to be considered a bold move, the APA has posted the draft of the DSM 5 on the web and made it available for reading and comment here. A variety of changes and non-changes are already attracting attention. One of my favorite blog authors, at Furious Seasons, has inspected enough of it to raise some concerns.
You can see for yourself (please), but here are the things I noticed browsing through the current draft in order of appearance:
Disorders usually first diagnosed in infancy, childhood, adolescence
I am especially concerned with the labeling of children with psychiatric disorders. For the most part, kids don’t “misbehave” because they are crazy. More likely explanations are that their behavior is a natural and even positive coping mechanism for dealing with seriously wrong family environment issues. Other common reasons for “odd” behavior in children are food or environmental allergies and medical or metabolic problems. Regardless of what the behaviorists might say, the reason why people act the way they do is sometimes very important and is often their best response they can have to biological, social and traumatic factors in their lives.
Temper dysregulation with dysphoria is proposed with the parameters available here. The positive side of this potentially stigmatizing new diagnosis for kids is that it is not the Child Bi-Polar Disorder that has been promoted by both the FDA and the friendly shrinks at Harvard. Of course any diagnosis invites the possibility of medicating the behavior but at least it won’t be an automatic road to a jumbo list of potentially dangerous mind altering chemical restraints. So, no doubt, they will have to develop a new list for this new diagnosis.
Another new diagnosis for kids, a conduct disorder, is labeled Callous and Unemotional Specifier for Conduct Disorder. This was not in the previous DSM. The jury is out how this might be suppressed with drugs.
Non Suicidal Self Injury has been added as a diagnosis for kids. I can hardly wait for the good folks at GSK or Lilly to bring out a new pill for this one. Since self-injurious behavior is often a normal response to severe trauma, it might be good if someone looked behind the curtain before attaching the label.
Some old/DSM 4 disorders for kids are being removed or subsumed under the heading of other existing disorder categories including Childhood Disintegrative Disorder, Asperger’s Disorder and Pervasive Developmental Disorder NOS, all of which will be under the general heading of Autism Spectrum Disorder. (That Child Disintegrative thing sounds very dangerous.)
We now have Psychotic Risk Disorder. There are plenty of subjective, unscientific criteria for this one. Like this phrase- “but of sufficient severity and/or frequency so as to be beyond normal“- I suppose you have to go to school to know what normal is. Just sop you won’t confuse it with other disorders they say “characteristic attenuated psychotic symptoms are not better explained by another DSM-V diagnosis“. That’s a relief.
Several types of Schizophrenia are being removed- paranoid type, catatonic type, disorganized type etc. I suppose they are all going to be under the general heading of Schizophrenia. Another to be removed is something called “Shared Psychotic Disorder”. I need to look that up- sounds like a friendly sort of illness. Misery loves company but psychosis no longer does in the new DSM.
Mindfreedom News/ lazy blogger
Off the subject (really) but related, there is a good collection of news from Mindfreedom here about the impact of the mental health consumer movement in Lane County, Oregon. Two news items of interest to Oregonians and others originated from Lane County today:
** Eugene Weekly newspaper covers alternatives to psychiatric drugs.
MindFreedom activists are quoted several times.
** Now you can compare Lane County’s ‘guidelines’ for empowerment of
mental health clients, with a stronger version recommended by Lane
County Mental Health Consumer/Survivor Council.
So check it out at the link above.
Check out the archived show celebrating famous people who died in 2009. There is not much more to say.