{"id":14942,"date":"2011-10-16T23:30:32","date_gmt":"2011-10-17T03:30:32","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=14942"},"modified":"2011-10-16T23:30:32","modified_gmt":"2011-10-17T03:30:32","slug":"frustration-getting-dressed-before-going-to-school-disorder","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/10\/16\/frustration-getting-dressed-before-going-to-school-disorder\/","title":{"rendered":"frustration-getting-dressed-before-going-to-school-Disorder…"},"content":{"rendered":"
I’ve followed both the series by Dr. Allen Frances [DSM5 in Distress<\/font><\/a><\/u><\/strong>] and Dr. Stuart Kaplan [Your Child Does Not Have Bipolar Disorder<\/font><\/a><\/u><\/strong>] in Psychology Today<\/font><\/strong> with interest. Here’s Dr. Frances’ most  recent column:<\/div>\n
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Should Temper Tantrums Be Made Into a DSM 5 Diagnosis?<\/font><\/u><\/a><\/strong>
Psychology Today<\/font><\/strong>
by Allen J. Frances, M.D.
October 11, 2011<\/div>\n

A recent front page story<\/font><\/strong><\/u><\/a> by Shari Roan in the Los Angeles Times explores the heated controversy over the DSM 5 proposal to include a Disruptive Mood Dysregulation Disorder [DMDD] in DSM 5. I very much oppose the inclusion of this new ‘disorder’- fearing that DMDD would medicalize temper tantrums in children and run the risk of exacerbating the already shameful overuse of antipsychotics.<\/sup><\/p>\n

When it comes to DMDD, everyone agrees on one thing only- that it is based on the thinnest possible research support; studies by one lone group for a mere six years. DMDD was largely dreamed up by the DSM 5 work group. They are trying to deal with a real problem – the massive overdiagnosis of childhood bipolar disorder and its attendant stigma and overprescription of potentially dangerous medication.<\/font><\/strong> But the proposed solution will create its own set of unintended consequences with the likely increase overprescription of medication for the new and inviting target of temper tantrums. And we are talking about lots of kids- estimated at 3% now and likely to grow to many more once the diagnosis is official and drug companies get their hands on it.<\/sup><\/p>\n

The right solution to the childhood bipolar fad is so much simpler and safer. DSM 5 should include a warning black box in its definition of Bipolar Disorder alerting clinicians to the dangers of overdiagnosis and overtreatment in children. My advice to child psychiatrists- tame the fad you have already created and please don’t create another fad of a new ‘disorder’ that can so easily be misused. No one denies that irritable children are a problem, but let’s not prematurely and blindly invent essentially meaningless, but potentially very dangerous labels for them.<\/font><\/strong><\/sup><\/p>\n

The truly incredible thing about child psychiatrists is their inability to learn from their past experience of fad creation. These are the people who brought us the three main fads of the past fifteen years- childhood bipolar, attention deficit disorder, and autism. And now they recklessly suggest a potential fourth in DMDD. DSM 5 clearly needs some adult supervision with this thought in mind- beware nosologists bearing new and untested child diagnoses.<\/sup><\/p>\n

This brings us to the most dispiriting chapter in this sad story. The DSM 5 ‘scientific review group’ has proven not to be scientific and seems incapable of careful reviewing. Most remarkably, it has approved DMDD on tissue thin evidence and with no consideration of risk. A porous filter indeed. This highlights the obvious necessity for independent and evidence based reviews [say by the Cochrane group] to ensure the scientific integrity and safety of DSM 5 suggestions.<\/sup><\/div>\n<\/blockquote>\n
The L.A.Times article itself is worth a read along with Dr. Frances’ comments [Child mental disorders: New diagnosis or another dilemma?<\/font><\/strong><\/u><\/a>]. When I read this, I was thinking about the parents who were commenting on the post about the Child and Adolescent Bipolar Foundation<\/font><\/strong> [what’s in a name? that which we call a rose…<\/font><\/a><\/strong>], thinking about how frustrating and confusing debates like this must be for them. They have a problem child that they want help with. They’re told one thing, then another. They read blogs where the focus is on the interference in the scientific process by the pharmaceutical companies, about corruption of the expert class in psychiatry, and then they find people who are anti-treatment altogether. What a maze for them to negotiate!<\/div>\n

<\/p>\n

I was drawn to this comment by Dr. Frances:<\/div>\n
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DMDD was largely dreamed up by the DSM 5 work group. They are trying to deal with a real problem – the massive overdiagnosis of childhood bipolar disorder and its attendant stigma and overprescription of potentially dangerous medication.<\/sup><\/div>\n<\/blockquote><\/div>\n
The L.A. Times<\/font><\/strong><\/u><\/a><\/font><\/strong><\/u> makes the same point:<\/div>\n
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The idea that bipolar illness can begin in childhood caught hold in the last decade. The number of outpatient visits for children diagnosed with bipolar disorder mushroomed from fewer than 200,000 a year in 1995 to 800,000 in 2003, according to a 2007 study in Archives of General Psychiatry. The study reinforced the notion that childhood bipolar disorder had become a fad diagnosis.<\/sup><\/div>\n

"The diagnosis means exposure to pretty potent medications," said Dr. Jan Fawcett, a psychiatrist at the University of New Mexico School of Medicine in Albuquerque. "And, if the diagnosis holds, it means lifetime exposure to these medications." Such children often receive drugs like lithium or Depakote, which can cause severe weight gain, sedation and involuntary muscle contractions. They aren’t prescribed antidepressants or stimulants, which could worsen the condition in children who are truly bipolar. If the diagnosis is incorrect, however, children are deprived of drugs that could alleviate their anxiety or depression.<\/sup><\/p>\n

"We had to do something about it<\/font><\/strong>," said Dr. David Shaffer, a child psychiatrist at Columbia University in New York and member of an American Psychiatric Assn. work group that proposed adding disruptive mood dysregulation disorder to the Diagnostic and Statistical Manual of Mental Disorders, the book that forms the bedrock of psychiatry. That would allow doctors to reclassify a significant portion of children who are considered bipolar<\/font><\/strong>, he said.<\/sup><\/div>\n<\/blockquote>\n
The little six year old girl is described as "painfully shy." The article gives this vignette:<\/div>\n
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The volatile 6-year-old had worked herself into a frenzy as she tried on outfit after outfit, rejecting each as unacceptable. The tantrum at full bore, she scooped up a pile of clothes and hurled them at the front door… The clock ticked past the school’s 8 a.m. bell. [Her mother] pulled her wailing child into her arms and held her on the couch. After several minutes, [She] stopped, took a breath and announced that she was ready to go to school.<\/sup><\/div>\n<\/blockquote>\n
It’s not much to go on, but I don’t think of a "Disorder" when I hear the case. My take on this one is that it points out a problem in the whole DSM system. What evidence is there that this child has a "Disorder" that she shares with others? Why is this not a temperamentally shy child with a going-to-school problem of the kind dealt with by parents and therapists for time immemorial? As Frances says, who needs a category for that? <\/div>\n

<\/p>\n

The notion that we would think about adding a "Disorder" to get psychiatrists to stop diagnosing "Bipolar Disorder" is ludicrous – like something out of a farcical play or a comedy. It’s hard to imagine grown, educated adults sitting around worrying about such things. The DSM-5 and its recent predecessors seem to think that we need a "Disorder" to explain every problem, every bump along the road of life. Next, they’ll be asking what would be the FDA approved way of treating this little girl’s frustration-getting-dressed-before-going-to-school "Disorder"? I’d suggest having the child seen by someone well schooled in child development and behavioral techniques to help her and her mother with this developmental deviation and her anxieties about going to school…<\/div>\n","protected":false},"excerpt":{"rendered":"

I’ve followed both the series by Dr. Allen Frances [DSM5 in Distress] and Dr. Stuart Kaplan [Your Child Does Not Have Bipolar Disorder] in Psychology Today with interest. Here’s Dr. Frances’ most  recent column: Should Temper Tantrums Be Made Into a DSM 5 Diagnosis? Psychology Today by Allen J. Frances, M.D. October 11, 2011 A […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-14942","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/14942","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=14942"}],"version-history":[{"count":12,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/14942\/revisions"}],"predecessor-version":[{"id":14954,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/14942\/revisions\/14954"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=14942"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=14942"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=14942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}