"Children's tantrums may be re-classed as psychiatric disorders"

silverharp

Its not my area but my initial reaction to reading the article was to roll my eyes. is it a profession trying to chase the cash? or simple technical update to mirror how patients are treated at the moment? any opinions?



http://www.guardian.co.uk/world/2010/feb/10/diagnostic-statistical-manual-proposals

Children's tantrums may be re-classed as psychiatric disorders

'Condition' may be included in new edition of Diagnostic and Statistical Manual, the industry bible

• Daniel Nasaw in Washington
• guardian.co.uk, Wednesday 10 February 2010 16.55 GMT
• Article history

Childhood temper tantrums, teenage irritability and binge eating may soon rate as psychiatric disorders in the US, according to proposed changes to the Diagnostic and Statistical Manual, the bible of the psychiatric profession.
The proposals are the product of a 10-year effort to update the handbook, which influences the vast network of American healthcare providers, insurance companies, courts, prisons and universities. At stake are billions of dollars in insurance payments, pharmaceutical sales and medical fees. The proposed revisions, published online today , will be subject to public comment until late April.
"It not only determines how mental disorders are diagnosed, it can impact how people see themselves and how we see each other," Alan Schatzberg, president of the American Psychiatric Association, which publishes the guide, told reporters. "It influences how research is conducted as well as what is researched. It affects legal matters, industry and government programmes."
The DSM is in its fourth edition. It has been criticised for formalising character traits and emotions into mental conditions and for encouraging their medical treatment, often with drugs that have powerful side effects.
Christopher Lane, a professor at Northwestern University and author of 2007 DSM critique Shyness: How Normal Behavior Became a Sickness, said: "The organisation is clearly opening another Pandora's box here, as well as paving the way for the medication of even-greater numbers of children and teenagers cycling through emotional stages as part of normal development."
In an email, Lane said that categorising binge eating as a psychiatric disorder risks classifying millions of Americans as mentally ill at a time when the country is trying to rein in health care costs.
Among the proposals is a new condition, "temper dysregulation with dysphoria", characterised by "severe, recurrent outbursts of temper" several times a week, that are "grossly out of proportion to the situation or provocation and that interfere significantly with functioning". To be considered, the "symptoms" must have been "diagnosed" before age 10.
The proposed revisions would also recognise binge eating as a disorder. The condition is "characterised by recurring episodes of the consumption of unusually large amounts of food, accompanied by a sense of loss of control and strong feelings of embarrassment and guilt". These episodes would need to occur at least once a week over the last three months, and the writers were keen to distinguish it from mere overeating.
"While overeating is a challenge for many Americans, recurrent binge eating is much less common and far more severe and is associated with significant physical and psychological problems," wrote Dr B Timothy Walsh.
The panels proposed a new category of condition called "risk syndromes", in which a patient is at risk for a mental disorder that is not yet present.
For example, a moody teenager who displays "excessive suspicion, delusions and disorganised speech or behaviour" may be labelled as having psychosis risk syndrome. The panel estimated that a quarter to a third of people who suffer from those "symptoms" go on to develop a psychotic disorder, and the writers acknowledged the new category could lead to inaccurate diagnosis of some who are not at risk.
"Given the severity of psychotic disorders, and evidence that early treatment may mitigate its long-term consequences, we believed that it was important to begin to recognise these conditions as early as possible," wrote Dr William Carpenter of the American Psychiatric Association's psychotic disorders work group.
The panels who proposed the revisions also took into account how race, ethnicity and gender affect the incidence of psychiatric disorders, and studied how those categories affect the expression of symptoms. For example, researchers noted differing ways of experiencing and describing symptoms of panic among some Asian and Hispanic patients.
The panel also recommended discarding the term "mental retardation" in diagnoses, replacing it with "intellectual disability".

Seems like a load of rubbish to me. Reminds me of a show i saw recently where some man (I didn't see the start so I don't know his background) from UK went to america to investigate medications being given to children. Some of the children were fairly obviously (from what they showed) just being bold, but it was "oh he has anxiety from his ADD and OCD" and all sorts of excuses calling it a disorder. I think in the period of the time the guy was there they quadrupled the child's medication :eek: He was only around 6-7...
There was another girl whose mother said she liked her daughter (teens) more when she was medicated... the girl said when she was off her meds she was just hyper... how can you justify calling everything a disorder and drugging them up??

For example, a moody teenager who displays "excessive suspicion, delusions and disorganised speech or behaviour" may be labelled as having psychosis risk syndrome.

Give me a break...

Valmont

Is there any one good website to follow for updates on the DSM? I wrote a short paper in 2007 on the proposed dimensional system of classification and I haven't really heard anything new since then.

Sofa so good

bluewolf wrote: »

Seems like a load of rubbish to me. Reminds me of a show i saw recently where some man (I didn't see the start so I don't know his background) from UK went to america to investigate medications being given to children. Some of the children were fairly obviously (from what they showed) just being bold, but it was "oh he has anxiety from his ADD and OCD" and all sorts of excuses calling it a disorder. I think in the period of the time the guy was there they quadrupled the child's medication :eek: He was only around 6-7...
There was another girl whose mother said she liked her daughter (teens) more when she was medicated... the girl said when she was off her meds she was just hyper... how can you justify calling everything a disorder and drugging them up??


Give me a break...

Bluewolf, you are making a lot of statements in one paragraph there.

ADD and Anxiety are frequently comorbid, failing to recognise ADHD as it's more frequently referred to is a real concern. So if that child was diagnosed with ADHD well then it is most likely the case that he has it. For ADHD psychostimluants are effective in combination with other measures, such as psychoeducation and addressing self-regulation. So I am not sure what point you are making here, or on what information you have based your need for a break.

You watched one, presumably biased, TV show and suddenly all diagnostic material is defunct?


I have only read the above extract, but in relation to risk for psychosis, and binge eating I think they seem like very good ideas. If people 'at risk' can be identified, educated about potential risk factors, or how to increase protective factors how is that a bad thing?


I agree that medication use should be done sparingly, but not to the cost of the well-being of thousands of people who may benefit. I know of numerous cases where medication has been of great benefit, in both psychiatric and otherwise, but very few where it has been detrimental.

mcmoustache

I know this isn't AH but it's worth a giggle in an otherwise serious thread.
Disclaimer: This is not a form of treatment recognised by the Irish Psychiatric Association.

https://www.youtube.com/watch?v=AW7cO01SpzI

Sofa so good

You're right it's not AH, so cop on and bring it over there.

http://www.russellbarkley.org/images/Consensus%202002.pdf

Gibs

Valmont wrote: »

Is there any one good website to follow for updates on the DSM? I wrote a short paper in 2007 on the proposed dimensional system of classification and I haven't really heard anything new since then.

www.dsm5.org


For me, one of the most disappointing aspects of the (highly criticised and flawed) DSM-5 revision process is the continued failure of the DSM designers to adopt a broader conceptual approach with regard to distress, i.e. one that incorporates the impact of the social context within which the person is embedded into the diagnoses themselves. The biopsychosocial philosophy is specifically spurned in favour of an explicitly stated commitment to a psychobiological model of distress and etiology. This fixation on the 'atomised', self-contained individual is disheartening as it still insists on locating the nexus of the problem inside the individual. Somewhat ironic, when you consider that the WHO and other researchers have found repeatedly that if you want to be able to predict whether or not someone will develop a 'mental illness' the piece of information that is most highly correlated with the later emergence and continuation of such a difficulty is not genetics, or brain disorders, or neurospychological difficulties or any of the other usual suspects within the individual. It's the level of poverty the person has been exposed to.



Here's the text from the DSM-V website regarding how they define a 'mental disorder'



Definition of a Mental Disorder

A proposed revision for the definition of a mental disorder is being addressed by select members of the Anxiety, Obsessive-Compulsive, Posttraumatic, and Dissociative Disorders Work Group, a member of the Mood Disorders Work Group, and additional individuals (see Stein DJ et al: What is a Mental/Psychiatric Disorders? From DSM-IV to DSM-V; Psychological Medicine, 2010; in press)

Features

A. A behavioral or psychological syndrome or pattern that occurs in an individual

B. The consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)

C. Must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals)

D. That reflects an underlying psychobiological dysfunction

E. That is not primarily a result of social deviance or conflicts with society

Other Considerations
F. That has diagnostic validity on the basis of various diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment)

G. That has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment)

H. No definition perfectly specifies precise boundaries for the concept of either “medical disorder” or "mental/psychiatric disorder”

I. Diagnostic validators and clinical utility should help differentiate a disorder from diagnostic “nearest neighbors”

J. When considering whether to add a mental/psychiatric condition to the nomenclature, or delete a mental/psychiatric condition from the nomenclature, potential benefits (for example, provide better patient care, stimulate new research) should outweigh potential harms (for example, hurt particular individuals, be subject to misuse)