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Posted on Saturday 1 December 2012

Weekend Vote Will Bring Controversial Changes To Psychiatrists’ Bible
NPR: All things Considered
by Alix Spiegel
November 30, 2012

This weekend, 20 people from around the country will meet in a nondescript hotel room in Arlington, Va., and take a vote. A passing stranger who stumbled on this group wouldn’t see much of anything, just a bunch of graying academic types sitting around a table. But millions of people will be touched by that vote because the graying academic types are voting to approve the 5th edition of the Diagnostic and Statistical Manual — the bible of psychiatry…

There will likely be a new childhood disorder called disruptive mood dysregulation disorder: The people in charge of childhood disorders proposed this diagnosis because they felt very strongly that too many children were being categorized as having bipolar disorder and then prescribed anti-psychotic drugs.

The hope is that psychiatrists will use this new diagnosis for kids, instead of bipolar disorder, and not prescribe as many drugs. Critics say it’s not clear that the change will work out, and that the history of mental health is littered with good intentions like this gone terribly wrong. But the hope is that it will shut down the rise of bipolar diagnoses in children…

There will be a new way to think about sadness in the wake of the death of a loved one: In the last DSM (DSM-4), psychiatrists were warned away from diagnosing major depression in people who had recently lost someone they loved, because grief in the face of loss was seen as a normal — not abnormal — response.

"That’s reasonable thinking, and certainly no one wants to pathologize grief or sadness or call it an illness when it is an absolutely normal human experience," said Dr. Sidney Zizook of the University of California, San Diego. But Zizook was one of the people who argued — probably successfully — to change that because, he says, telling psychiatrists that people who are grieving shouldn’t be diagnosed as depressive "excludes a bereaved person from being diagnosed with depression, if they have a depression, and no one wants to do that, either"…

Chris Lane, author of Shyness: How Normal Behavior Became a Sickness, is a DSM critic. He worries the new version will label people sick when they are not. "I’m very concerned about the number of false positives from this edition," he says. "That is, the number of people who are overdiagnosed." Roger Peele of the APA obviously doesn’t agree, which doesn’t mean that he thinks the DSM-5 is infallible. "It’s important that people not see the DSM as a bible," he says, "that they respect it but don’t worship it"…
In each of these examples, the argument is based on what the clinicians might do in response to the diagnosis. Diagnosis is being defined by it’s consequences not the characteristics of the illness. So the DSM-5 is kind of like The Bible:
  • Thou shalt not give antipsychotics to disruptive kids;
  • Thou shalt not withhold antidepressants from the pathologically bereaved;
  • Thou shalt not label people.
It’s the APA’s mistake to make, playing God, and it looks as if they’ll go ahead and make it. A missed opportunity, and a big error…
    Bernard Carroll
    December 1, 2012 | 12:22 PM

    The logic displayed by Dr. Zisook concerning the bereavement exclusion illustrates the scientific poverty of DSM-5 depression diagnoses as well as the disregard for practical consequences. To pick up on the latter issue first: Zisook’s agnostic position will result in many, many more false positive diagnoses of depression, which will not be offset by a comparable number of rescued false negatives. The tradeoff is not favorable, and it will result in diagnostic excess with consequent unnecessary psychotropic drug use.

    As to the scientific poverty of DSM-5 depression diagnoses, DSM-5 repeats the missteps of its predecessors by offering a menu of symptoms without coherent underlying constructs. Dr. Zisook usually biases his discussions by depicting a melancholic post-bereavement syndrome, but that isn’t what DSM-5 requires – far from it – generic, dumbed down major depression (whatever that is) will suffice. Melancholia isn’t what thousands of primary care providers will be seeing when they reach for their prescription pads. Will Pharma move quickly to capitalize on this opening? Count on it.

    December 1, 2012 | 4:24 PM

    Why would clinicians treat “disruptive mood dysregulation disorder” any differently than they treat child bipolar disorder?

    What are the recommended treatments for “disruptive mood dysregulation disorder”? Now we’ll see a bunch of studies showing antipsychotics are just the ticket — not because anyone is interested in what causes kids to act out, but to justify long-held prescribing habits. Surely a chemical cosh will calm the kid down.

    The usual bad logic from the APA. I suspect they’re ashamed of the expansion of child bipolar disorder, so they re-brand it something else to preserve their egos.

    December 1, 2012 | 4:24 PM

    GREAT BLOG 1BoringOldMan and hardly Boring…
    And you aren’t the only 1BoringOldMan out there calling it as you KNOW IT TO BE!

    I invite you to view take2la on the MSN site NEWSVINE (create your own acct free) and bring the world into your blog-o-sphere
    We need your expertise.
    If not… KEEP BLOGGING and I’ll link to you anyway.

    December 1, 2012 | 5:56 PM

    Dr. Carroll,

    Very well put.

    Bernard Carroll
    December 3, 2012 | 12:46 AM

    Thanks for the compliment… To paraphrase Humphrey Bogart, stick with the 1boringoldman blog and you’ll learn things.

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