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Yesterday, the board of trustees of the American Psychiatric Association approved the new DSM-5, aka Diagnostic and Statistical Manual, the controversial compendium of official definitions of "what constellations of symptoms doctors recognize as mental disorders," and diagnostic labels and categories insurance companies use to determine payments for services for mental illness. The new volume will be published in May of 2013.  

In DSM-5: Psychiatrists OK Vast Changes To Diagnosis Manual, Lindsey Tanner describes three of the more controversial changes; dropping Asperger's disorder which is now included in "autism spectrum disorder, a new disruptive mood dysregulation disorder, and changing "gender identify disorder," now labeled as a mental illness, to "gender dysphoria," a condition of unhappiness about one's physically manifested gender."  

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms. ...

A new diagnosis for severe recurrent temper tantrums – disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums. ...

Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

Below the squiggle I offer a more detailed description of the new DSM-V, from Science Decoded, and more extensive detail and some of the major criticisms of the whole methodology from Wikipedia.  




In Diagnostic and Statistical Manual V: Small Changes with Big Implications Gina Putt, of Science Decoded, offers us more insights into the changes in the new DSM-V, with a view of how if affects women and other "kinder and gentler" changes, "such as the elimination of 'mentall retardation' in favor of 'intellectual developmental disorder.'"

According to Recovery Today Online, one major anticipated change in the new DSM-V will eliminate the category of “substance abuse and dependence” and replace it with “addictions and related disorders.”   While the difference may seem semantic, the intent is to clarify that withdrawal is a normal response to the discontinuance of some medications, “whereas addiction is compulsive-drug seeking behavior.”  The emphasis would now be on the behavior, rather than the physical response. ...

Gender Identity Disorder to Become Gender Dysphoria?
In what could be seen as a political move, the DSM-V is expected to focus more on the unhappiness that gender identity problems may cause rather than the issue of gender identity itself.  Everyday Health notes that it is problematic if psychiatry ”casts one’s identity as an illness.”  Focusing on emotional, rather than a state of being, appears to address this issue. ...

Some of the proposed changes have a disproportionate impact on women.  Men would be unlikely to be diagnosed with the newly proposed “premenstrual dysphoric disorder.” As with gender dysphoria, the intent appears to be to focus on the emotions associated with PMS rather than menstruation itself.
Proposed upgrades to the personality disorders category are heartening.  Women were frequently diagnosed as “histrionic” a personality disorder that is slated for deletion.  The “disorder” included many criteria such as shallow relationships, focus on self, over dramatization and seductiveness. ...

Hoarding and binge eating have been on the scene for a while.  Originally considered a type of OCD (obsessive-compulsive disorder) hoarding is understood to have distinct features. Binge eating, once only in the appendix of the DSM-IV will most likely be added to same category as anorexia.  Children will no longer be bi-polar, but could instead be categorized as having “disruptive mood regulation disorder” to distinguish their issues from adult bi-polar disorder, which may keep children from being mislabeled and potentially, inappropriately medicated.

No discussion of the DSM-5 would be complete without noting some of the controversies and criticism of the entire approach, misuse of the categories, and methodological challenges, for which I draw from Wikipedia's excellent entry for DSM-V.

The British Psychological Society in the United Kingdom stated in its June 2011 response that it had "more concerns than plaudits".[59] It criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations", noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders.

It also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation".

The Society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with normality:

[We recommend] a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or 'symptoms' or 'complaints'...... We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc)? These would be more helpful too in terms of epidemiology.

Overall, my first impression is that these changes represent improvements especially with regard to greater sensitivity to the language used that in the previous versions unnecessary stigmatized those with conditions that may be useful to diagnose for insurance purposes, but which should not be labelled cruelly, or pejoratively as mental illness.  

Also, I haven't had time yet to study why  the proposed "internet addiction," and "compulsive Daily Kos posting disorder, CDKPD," were not included, but I guess I should consider myself lucky not to have even more diagnostic labels than I already do.

Since my name as somehow been on the top of the "most frequent posters of the month" list now for almost two weeks even after Markos posted 70 in the election week alone, and I took off a whole week for Thanksgiving, I'm getting a little worried.  Maybe this is another broken listing like the broken comment rating and Mojo counters which have been broken for over a year and a half? Because I've cut way back on posting.  Really I have! I'm only an occasional "social" poster, now. But, my friends keep sending me literature on these 12-step programs for blogging addicts.    

Originally posted to HoundDog on Sun Dec 02, 2012 at 07:23 AM PST.

Also republished by Mental Health Awareness.

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Comment Preferences

  •  If CDKPD was a legitimate disorder (7+ / 0-)

    Man, insurance companies would be boned. I'd have so many recurring treatment needs.

    Still, the DSM V does have a profound impact on discourse in this country whether people are aware of it or not, so I say anything that elminates stigmas is a good thing. Thanks for keeping us informed!

  •  May I suggest ... (10+ / 0-)
    Hoarding is understood to have distinct features
    to include the intentional suppression of memory,  also known as Romnesia.

    If cats could blog, they wouldn't

    by crystal eyes on Sun Dec 02, 2012 at 07:29:27 AM PST

  •  A lot of this stuff (17+ / 0-)

    relates to billing now.  The diagnoses in the DSM will translate into diagnoses in the ICD-9 (soon to be ICD-10) billing codes, and those changes will translate into changes in what insurers cover and won't cover (e.g., they will pay for treatment for one code, but not another code).

    The last 15 years has seen an expansion of required coverage for mental health, which will continue with health care reform.  So I'm hopeful that more people who need help will be able to get it.  If that's the end effect of these changes in the DSM-V, I'm in favor of them.  If insurers try to use these changes to somehow reduce eligibility for coverage, well then I'm against them.

    •  Excellent points Tailfish, I agree. Thanks for (7+ / 0-)


      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Sun Dec 02, 2012 at 07:45:59 AM PST

      [ Parent ]

    •  Also accommodation. I wonder if all of us (8+ / 0-)

      Aspies will have to get reclassified, or if the old IEPs could be used for educational accommodation.

      •  IEP's don't rely on medical DX (8+ / 0-)

        they are based on classifications made up by the fed, those classifications are often based on medical conditions, but not always. Learning disabilities, emotional disturbance, social maladjustment, communication impaired, are a few that do not require a medical workup. These can be determined by speech therpists, social workers, and school psychologists. Often, though, parents will have had a medical workup already finished by the time they get to the school's team; sometimes a school can override a doctor's recommendation, because it doesn't meet the state's criteria. For example, a doctor can say the kid has learning disabilities, but the school's tests, usually a Woodcock-Johnson and an IQ test ( the best is the WISC but some use the Kaufman or the DAS; they should alll be around the same score but sometimes show differences ) will not show it. That's where we get into difficulty; kids can be 'slow" but not LD; also they can be "bright" but have an LD. Thing s is, so called "slow" kids benefit from the same interventions as LD kids, which puts the whole thing into question....i know a professor at a college in Nj who is getting higher functioning Down's students into college classes and they are actually "getting" it. Fascinating stuff.

      •  Special Ed classification is (1+ / 0-)
        Recommended by:

        based on different diagnostic classifications (based on IDIEA).  New DSM will likely not change this though new conditions will now be covered under Other Health Impairment.  

    •  yes, and who knows how insurance companies (2+ / 0-)
      Recommended by:
      HoundDog, mapamp

      will handle this. But with Obamacare in place, there should be some supervision of insurance companies, something we've never had before.

      We're not perfect, but they're nuts! -- Barney Frank

      by Tamar on Sun Dec 02, 2012 at 11:38:58 AM PST

      [ Parent ]

  •  The 2 that will most affect the families (10+ / 0-)

    of the little ones I do Speech Therapy with will be the Autism diagnosis and the severe recurrent temper tantrums. I work with children ages 3-5.

    Some of the parents are concerned that their children with Aspergers will be lost in the crowd, and that therapies that work better for their children will be lost to overgeneralizing treatment programs.

    Severe recurrent temper tantrums is interesting, as I have seen children diagnosed with Disruptive Behavior Disorder, Obsessive Compulsive Disorder, and AD/HD. I am wondering if these will change to the new diagnosis. I am also wondering if some of my little ones on the Spectrum will be diagnosed with the temper tantrum diagnosis first.

    My goals in Speech Therapy address a child's need to communicate, no matter the diagnosis. It helps to have an understanding of a child's diagnosis, but in the long run; their behavior is often their communication. If I can teach children to use more socially appropriate communication techniques, how to use intelligible speech, vocabulary and sentences, work to develop an augmentative communication system (if needed); AND....they see that these skills will work more effectively for them than their behaviors.....THEN, they have made a huge gain before kindergarten begins.

    I will be interested in seeing how supports to families are changed or not changed, based on these new diagnoses. That will be the crucial piece. If supports, such as Behavior Consultation and Therapeutic Staff Support AND Special Education services remain in place or are augmented; it will be all good in the end. If there are children overlooked for services, because they won't fit under the umbrellas set up for them; then it will be distressing.

    Peace, Hope, Faith, Love

    by mapamp on Sun Dec 02, 2012 at 08:09:00 AM PST

    •  I've got a son with ASperger's (7+ / 0-)

      dx'ed a year ago; his problem is largely social; his academics lately could be better but basically he has made honor roll every marking period for years, even if lately it is by a hair. I really don't think, in my social worker opinion ( and I do work in schools with this population ) that Aspies really should be lumped in with people that can't communicate.  I have seen some HFA kids who look a lot like Aspies in their behaviors and conversation, only more extreme, but when it come to academics they are completely on a different level, often requiring a self contained class or an autisitic class for academics. In my experience, Aspies don't need that. I'm thinking people will look at this in 25 years and say this was a mistake.

      •  I'm guessing you are right (8+ / 0-)

        about the change. I really am not thrilled with the "Let's lump everyone together" thought, as well.

        My nephew is a young man with Asperger's. He is working to finish an Associate's Degree in Computer Science. His sensory needs, make it hard for him to sometimes attend, and he must move. The university has been wonderful with him, as have his professors. They know his unbelievable brilliance will eventually serve him well with what he wants to do. I wonder if his diagnosis had been straight Autism, if they would be so accommodating.

        There are truly differences between the 2. And there are differences in specific needs for the 2, especially when children reach middle school and high school.

        I'm on the side of worry that the kids with Asperger's will either be completely overlooked down the line, or they will be lumped in with others and their needs will not be addressed.

        The kids I worry about most are those whose parents are not savvy concerning their children's rights for education and mental health services. Even my sister, a nurse practitioner, was hesitant to challenge the school district about services--she didn't want to "rock the boat".

        I'm really hoping these new diagnoses won't be used to keep services away from the children who need them.

        Peace, Hope, Faith, Love

        by mapamp on Sun Dec 02, 2012 at 08:36:50 AM PST

        [ Parent ]

        •  I hope we all agree with this. (4+ / 0-)
          Recommended by:
          4Freedom, remembrance, corvo, mapamp
          I'm really hoping these new diagnoses won't be used to keep services away from the children who need them.
          But, if our Democratic leaders agree with Republicans to reduce funding for Medicare and Medicaid even further we should expect it.

          There  is only so far we go with this idea that we are "only reducing funding to providers" so we eliminate waste and fraud before real services are reduced. Beneficiaries already feeling the de facto "rationing" that is going know this is often BS.

          The means is the ends in the process of becoming. - Mahatma Gandhi

          by HoundDog on Sun Dec 02, 2012 at 10:11:42 AM PST

          [ Parent ]

          •  so far what has been proposed for Medicare by (2+ / 0-)
            Recommended by:
            HoundDog, mapamp

            Obama is pretty much okay -- but I agree that it probably goes as far as it can without cutting into benefits. (one part of his proposal is increased Medicare premiums for higher income seniors which makes sense, IMO).
            I know that one thing that makes the White House a little more optimistic is the hope, with some justification, that when Obamacare is implemented it will cut health care costs in general and that's good for Medicare.
            What needs to be done in Medicare is
            1) negotiate for better drug prices, and
            2) expand the base (the exact opposite of what the Republicans want). Younger healthier people in the system will help balance things out. And in fact I heard Howard Dean make an extremely good point -- that raising the eligibility age the way McConnell is suggesting saves very little money because you're dropping people at the healthier end of the spectrum (because they're younger). And the burden for their coverage is transferred to the individuals who will end up with expensive premiums (because they are at the older end of the non-elderly population and now will be stuck with buying private insurance) that will probably have to be subsidized in many cases by the government. More profits for insurance companies, increased expenses for government some of which will go to those profits, and no real savings. A perfect Republican plan.

            We're not perfect, but they're nuts! -- Barney Frank

            by Tamar on Sun Dec 02, 2012 at 11:53:07 AM PST

            [ Parent ]

            •  I could probably leave with higher premiums (1+ / 0-)
              Recommended by:

              for the most wealth, or giving Medicare the ability to negotiated with big Pharma, but I strongly oppose raising elegibility age, are more of this across $700 billion cuts under the premise they are all just fraud, or over billing.

              I didn't fight it out of Party loyalty but I'm still cheese off and lost respect for a lot of people in our Party, because once one looks at the details about about a third was hospital reimbursement at a time when the Mayo Clinics of AZ are not even accepting Medicare patients any longer.  

              And, a lot of us have difficult getting appointments.  It was probably the primary reason the Democrats lost in 2010, and many seniors do not trust the Democrats as ironic as that is.

              Anyone are any Party who goes after Social Security or Medicare will pay a serious price.  

              The means is the ends in the process of becoming. - Mahatma Gandhi

              by HoundDog on Sun Dec 02, 2012 at 02:06:02 PM PST

              [ Parent ]

              •  I worked on health reform as my job for a couple (2+ / 0-)
                Recommended by:
                sydneyluv, mapamp

                of decades. While Bush was still in office, our organization was fighting the insurance companies on the so-called Medicare Advantage. Medicare was paying these companies something like a 12% bonus for no good reason. When there was discussion in Congress about ending that over-payment, the insurance companies came up with a completely fraudulent table that supposedly showed Medicare Advantage disproportionately served minority seniors. Actually, the percentage of Medicare Advantage enrollees who were minority was exactly the same as the percentage in the rest of Medicare.
                So cutting that over-payment to insurance companies is really not cutting into the meat of anything. It's just like (as someone else pointed out, I think) getting rid of the middle-men financial for-profits in the student loan program.
                Other cuts are not so clear but I'm keeping an open mind. I think it's fine to have wealthier seniors pay more in premiums -- I believe premiums are already on a sliding scale so it's not violating any principle.

                We're not perfect, but they're nuts! -- Barney Frank

                by Tamar on Sun Dec 02, 2012 at 03:04:59 PM PST

                [ Parent ]

                •  I'm just about to get a Medicare Advantage plan (1+ / 0-)
                  Recommended by:

                  as its is seems to be the best way to protect against uncapped 20% hospital co-pays in the even of hospitalization.

                  Also, they are popular because many include dental, gymnasiums, and preventive care.

                  I don't know what the truth of the matter is Tamar, perhaps, there was some extra profits for providers in these plans, but I know for sure we Democrats blew the public relations on this move.  

                  One CBO study I read said that the Medicare Advantage Plans were only 1/3 of of the original $500 million taken out.

                  And as someone said recently, as far as voters are concerned perceptions are reality.  Several studies I've read indicated this was the main reason we lost in 2010, and many seniors who feel confident we were lying about it still don't trust us.

                  After polling on this Mitt Romney through Paul Ryan under the bus, and changed his position to say he would put the $700 billion Obama took out back.  

                  I'd be willing to do that if we could take it out of military instead.  We wouldn't have to put it back into Advantage plans, necessarily if there is or was something really wrong with them, but trust is low and anger and suspicion is high..  There are some Democrats I will never trust again for what seem to me to be lies about this.

                  I held my tongue through out the election, but if any major Democrats try to do this again I will have to speak out aggressively as will many others dedicated to keeping faith with our Social Security, Medicare and Medicaid recipients and at I time when we've added hundreds of billions a year to relatively useless military spending.

                  The means is the ends in the process of becoming. - Mahatma Gandhi

                  by HoundDog on Sun Dec 02, 2012 at 03:37:01 PM PST

                  [ Parent ]

                  •  I have no problem with the Medicare Advantage (2+ / 0-)
                    Recommended by:
                    mapamp, HoundDog

                    program, just the over-payment. No reason to end the program at all since it has been good for some people.
                    And yeah, I don't think we got the message across well including that Ryan planned on the exact same "savings" ($716 billion) but he wasn't going to use it to help out with health coverage.
                    My understanding is the $716 billion Obama took was used for a combo of things including increased benefits for seniors: helping with the donut hole in prescription benefits and making preventive care under Medicare free (no copayments). The rest, IIRC, was used for funding in Obamacare. So it was excessive profits to insurance companies being pulled to improve health coverage for Americans.
                    Ryan would take that money away completely from anything that benefited regular people.

                    We're not perfect, but they're nuts! -- Barney Frank

                    by Tamar on Sun Dec 02, 2012 at 06:01:28 PM PST

                    [ Parent ]

                    •  This is partially true. I strongly favor the ACA (0+ / 0-)

                      and yes, we transferred to fund to good, perhaps, even better use there.  But, as a Party we appear to have lied to to do it.  

                      The CBO study I read indicated that only 1/3 of if was from Medicare the rest was from Hospitals reimbursement.  Hospitals may have been happy to rob Peter to pay Paul, but I fear Medicare seniors and disabled have and will pay a price.  And, I know for sure many of us perceive that to be true, and I lost respect for some of our Party apparatchuks (sp?) who went around making this bogus claim and many here, including myself compromised our integrity to Party loyalty to win this election and prevent the President's favorable from plummeting two year ago, when it was in serious jeopardy.

                      I'm actual quite angry about it and expect many others are as well, meaning that the next Democrats to do something like this may pay an extra price due to pent up "accountability."

                      If we believed funds could be better used in such a transfers we should have been honest about it, rather than be duplicitous. I personally know several seniors who will never trust Democrats again.  And, when I remind them that Paul Ryan and many Republicans want to kill these programs some say "well at least they were honest about it, while others don't believe it and point to Romney's position.

                      But, the most outrageous thing is that we've added trillions to comparatively worthless military expenditures without so much as a blink.  

                      And, we the reason we choose to take the ACA money out of Medicare rather than trim back military expenditures was pure political expediency.

                      And, I believe there are more than a few Democrats planning at this very moment to do the exact thing over again.

                      If they do, I have already vowed to spend the remainder of my life holding them accountable.

                      The means is the ends in the process of becoming. - Mahatma Gandhi

                      by HoundDog on Sun Dec 02, 2012 at 07:49:20 PM PST

                      [ Parent ]

                      •  on the hospitals -- they actually agreed to it on (0+ / 0-)

                        the basis that they will have fewer uninsured patients.
                        The money came from what's called DSH payments -- I know of that from my Medicaid work which also has DSH payments. DSH is Disproportionate Share Hospital payments that the federal government gives to hospitals that have a disproportionate share of indigent/uninsured patients. The ACA is good for hospitals because it reduces the # of no-pay patients hospitals will have to treat. So the idea is that they forgo the DSH payments in return for a better insured (read: more likely to pay) population of patients.
                        I don't know where but I remember reading that the hospitals found that acceptable. Believe me, they have a very strong lobby so I think we would have heard a lot of screaming if they weren't okay with this shift in funding.

                        We're not perfect, but they're nuts! -- Barney Frank

                        by Tamar on Mon Dec 03, 2012 at 02:30:47 PM PST

                        [ Parent ]

      •  if you read Hans Asperger's original writings (6+ / 0-)

        they are very insightful and many of his observations are still valid for this population. But I think the issue is, it's well-known that few people really have exactly all of the symptoms he describes, or at least they are going to have them in varying degrees. So it's not one syndrome but a spectrum, and in that respect the new DSM is more accurate.

        One of the variables is how much language difficulty someone has. My state has criteria for getting autism-related services that focus on language delay among other factors, and HFA/Aspies don't qualify in many cases. So they're already falling through the cracks because the system is more set up for a different part of the spectrum.

        Another concern is that my daughter is just getting around to understanding a bit and accepting her own diagnosis (which has been variously Asperger's and PDD/NOS). So she's not happy about having it morphed now into "autism spectrum disorder." I explained that laypeople are probably going to keep on saying Asperger's, but psychiatrists will call it something different now.

    •  Thanks for this most excellent comment Mapamp. (5+ / 0-)
      Recommended by:
      whaddaya, 4Freedom, remembrance, Tamar, mapamp

      I've read that many "problematic" children were over diagnosed with ADHD, for the lack of other diagnostic categories that could get insurance funding for treatment.

      Is it possible some of these children with server temper tantrum  issues are being diagnosed in desperation as ADD, and then end up through the system given amphetamines for treatment making things worse?

      Even though I've joked elsewhere about the apparent tendency to turn all variations in human nature and behavior into pathologies, I still support your idea of greater differentiation and accuracy in diagnostic categories when it can help people get more appropriate treatment of needed help.  

      Part of the problem is not just in the validity of the categories but how they are used and who does the using.

      If caring and loving people are trying to help people in distress and a diagnosis or diagnostic category helps get funding, or better targeted and appropriate care this seem good.

      If insurance companies, or people and system with dubious motives use a patient diagnoses to exclude people from employment, schools, deny treatment, inappropriately or unfairly incarcerate etc. then this seems bad.

      At the risk of appearing simple minded, as a general rule I favor more of the good things and oppose the bad things. Does this simple lay approach qualify me for any of the new diagnostic criteria?  

      Thanks for this great comment.  

      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Sun Dec 02, 2012 at 09:56:00 AM PST

      [ Parent ]

      •  yep, you're clearly "splitting" by wanting (2+ / 0-)
        Recommended by:
        HoundDog, mapamp

        good things to go forward and bad things to be stopped. I think you might be diagnosed as  "Progressive" or  "Liberal," which means you should seek help as soon as possible. I think a few sessions with Dr. Laura would cure what ails you (probably lead to you jumping of a cliff -- which is a pretty definitive way of getting cured!).

        We're not perfect, but they're nuts! -- Barney Frank

        by Tamar on Sun Dec 02, 2012 at 11:59:37 AM PST

        [ Parent ]

    •  my husband, a shrink, says the reclassification (3+ / 0-)
      Recommended by:
      HoundDog, sydneyluv, mapamp

      of some conditions that used to be considered bipolar in children into the disruptive mood category is good. He sees a number of children with this problem and didn't agree that they should be in the bipolar category. (and he sees lots and lots of kids since he works half-time in a county clinic).
      I asked him about the long-term prognosis for this condition and he said that many kids with this end up with depression rather than bipolar disorder when they're adults.

      We're not perfect, but they're nuts! -- Barney Frank

      by Tamar on Sun Dec 02, 2012 at 11:44:36 AM PST

      [ Parent ]

  •  It's definitely not complete. It lacks the (8+ / 0-)

    category "Handheld Gadget Attention Deficit Disorder"

    With that we could treat oh I don't know, 80% of the population? It's a true epidemic. But only to those who don't have it and are aware of the world around them or that there is in fact a world outside of themselves at all.

    "Fortunately, I'm adhering to a pretty strict, uh, drug regimen to keep my mind, you know, uh, limber." The Dude

    by Methinks They Lie on Sun Dec 02, 2012 at 08:30:00 AM PST

  •  DSM-5 retained Narcissistic Personality Disorder (6+ / 0-)

    ...and I'm glad they did.  I've had enough dealings with people with NPD and anti-social people to know they are not the same thing.  Lumping them together would have been a mistake.

    "The party of ideas has become the party of Beavis and Butthead." ~ Paul Krugman.

    by Neon Vincent on Sun Dec 02, 2012 at 08:32:27 AM PST

    •  They are special! (2+ / 0-)
      Recommended by:
      Neon Vincent, mapamp

      I was raised by such an individual and it was quite an experience. My mother was intensely social. Society was a banquet laid out for her narcissism to feast upon.

      She wasn't the least bit anti-social. But she was very fussy about who she would associate with. However, once someone was on the approved list, and there were many, she maintained communications with them throughout her life.

      Human salvation lies in the hands of the creatively maladjusted. -- Martin Luther King, Jr.,

      by 4Freedom on Sun Dec 02, 2012 at 11:26:05 AM PST

      [ Parent ]

  •  Big Pharma has been behind a lot of the changes (6+ / 0-)

    now, if a DSM code can describe it, BigPharma can prescribe it.

    There has been much talk that the real reason for the move to include diagnoses such as

    Some of the proposed changes have a disproportionate impact on women.  Men would be unlikely to be diagnosed with the newly proposed “premenstrual dysphoric disorder.” As with gender dysphoria, the intent appears to be to focus on the emotions associated with PMS rather than menstruation itself.
    Ah, forget the fact that women have been dealing w/PMS for generations, now BigPharma is nicely positioned to give you a pill for it by convincing you and your doctor and therapist that you should feel happy all the time.  Serious hormonal issues obviously need to be dealt with biochemically, but I am talking about the huge pr campaign BigPharma has been waging to NORMALIZE taking drugs to counteract human emotions and feelings that they are telling you are 'out of the norm.'  ("Do you sometimes feel anxious, when you see a tornado coming directly at you?  Ask your doctor if you need "Blotto-pills" designed to restore you to being calm in all circumstances.)

    What is the DSM but the attempt to normalize dysfunctions through statisical models that come from BigPharma research.

    The Brits have it right:

    It also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation".
    This is an issue worth an expose.  There has been some discussion and writing about it, but hey, the tee vee tells me that if I question authority, they have a drug for me.

    Soma here we come!

    Brave New World Theme of Drugs and Alcohol

    The drug in question here is soma, a hallucinogen used by those in power to subdue the citizens in Brave New World's futuristic, totalitarian setting. It is described as "the perfect drug," with all the benefits (calming, surrealistic, ten-hour long highs) with none of the drawbacks (no guilt, no hangovers). The citizens of the "World State" have been conditioned to love the drug, and they use it to escape any momentary bouts of dissatisfaction. The problem, as one character identifies, is that the citizens are essentially enslaved by the drug and turned into mindless drones. No drawbacks indeed.

    To Repeat, BigPharma's involvement in shaping diagnoses so that they can then push drugs, is a very big story waiting to be exposed.  People are talking about it, but it is not getting media attention.

    Hum?  I wonder why that is?

    It is enough that the people know there was an election. The people who cast the votes decide nothing. The people who count the votes decide everything. ~~Joseph Stalin

    by SeaTurtle on Sun Dec 02, 2012 at 08:59:37 AM PST

    •  A most excellent point SeaTurtle. Now I'm glad (7+ / 0-)

      I left the British criticisms in as I was strongly tempted to take it out to double readers-ship, comments and recs.  

      That's  about the average statistic for posts this long.

      But you most excellent comment is worth whatever number of readers I lost who skipped it when they saw the length.

      This idea of the "pathologization  (spelling?) of human diversity" is a big issue, as well as the increasing roles mega-corporations and insurance companies have in creating new diagnostic categories.

      I was going to joke that I may be a victim of "Age Related Disphoria" and need new meds to fix this ASAP.

      And, you sound as if you are suffering from "Excess Questioning of Authority Syndrome," as well as "Skeptical Progressive Distrust of Corporations Dysfunction" as well, which my understanding may jeopardize you qualification for voting in Arizona, and Florida under the new voter ID and qualification laws.

      What can be done about this. Your brave new world reference is sort of scary. Under medical-social systems we can imagine within this next century, people like you am me might be identified in pre-screening tests as children and medicated in advance to prevent the kind of depressing and angry emotions we experienced under the Reagan, Nixon, and Bush administrations as "Liberal-Progressive Dyphoria" or "Anti-Totalitarian Hyper-Sensitivity Derangement."

      Spending excess time on the internet commiserating with other sufferers and complaining is just one of the diagnostic criteria we already meet. Suffering from grandiose delusions that we can change the world to conform to our idealistic delusional fantasies with grass roots Netrooting is a second.

      And paranoid ideation that big Pharmaceutical companies would deploy and employ the same kind of tracking databases  the chemical companies keep on EPA employees and environmentalists is a third.

      Egads we're doomed!


      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Sun Dec 02, 2012 at 09:39:56 AM PST

      [ Parent ]

      •  actually, HD, it was your Brit quote that got me (4+ / 0-)
        Recommended by:
        4Freedom, corvo, HoundDog, mapamp

        because, for me, it presented a greater depth perspective than just reporting on the DSM.  So, I am glad that you included it.

        I am totally convinced that there is an equivalent "Alex" w/regards to the medical profession who works with insurance companies, BigPharma, Big 'for profit' Hospital complexes to influence the content of professional group's standards (such as the APA,) in such a way as to provide a segue into making money, more money than we can imagine, from those standards.  And then if legislation is needed, they have 'bought and paid for' politicians who are only to willing to bury in bills language which either remove s liability (flu vaccine,) or allows non-competitiveness (Medicare and prescriptions,) or whatever else they consider in the best interests of their bottom line.  It has been widely reported that Big 'for profit' Medicine is driving out individual or group medical practices viewing them as competitors in their one and only goal: making money.  Once again, monopolies are being constructed and the public is forced into a my way or the highway product.

        Right now there exists a very, very strong push to CREATE MEDICAL/PHARMACEUTICAL NEEDS BY SCARING THE SHIT OUT OF YOU BY PATHOLOGIZING NORMAL OR NOT ABNORMAL EVENTS.  Most people can see the evidence of the trillions of dollars BigPharma and Big Medicine is spending on tv ads:  ("If you bruise yourself when playing football, you could have a serious condition called 'bruisetoomuchitis' and it can lead to premature death, not to mention premature ejaculation.  Our professionals at ScamHospital will be only too happy to evaluate your condition and prevent further damage from occurring.  We have the latest techniques, a silicon formula patented in China, which we will inject into your blood stream to prevent the veins from being damaged.  Serious side effects may be immediate heart attack, secondary death from poisoning and early aging if you live longer than three days after the procedure.)  Have you ever listened to the side effects that their lawyers demand they list after touting a 'miracle cure.'

        Let me see?  These insurance/medical companies are spending trillions of dollars on advertising to create new, unnecessary needs for the products they are pushing, yet are refusing to provide for the genuine needs of people.  They scream they cannot afford to pay for treatment for someone who is seriously ill  because they view their advertising and pr as a higher priority than the health and life of their patienets.  And besides they need their patients to live, so they can continue to suck them dry.

        Oh Kay.... I may have feelings about this.

        One really good concrete first step would be to identify the "Alec" behind the insurance/BigPharma/BigMedicine industries and educate the public about what is really going on behind the scenes.  It seems to me that a lot of good was done by exposing Alec; hopefully benefit can be brought here if we can find the wizards behind the screen.  We need to find them and tell everyone about them.  

        And live to tell about it.

        Oh kay,  Rant over.  I'll go and take my blue pills.................

        It is enough that the people know there was an election. The people who cast the votes decide nothing. The people who count the votes decide everything. ~~Joseph Stalin

        by SeaTurtle on Sun Dec 02, 2012 at 11:22:02 AM PST

        [ Parent ]

    •  While I don't doubt that the drug companies (3+ / 0-)
      Recommended by:
      HoundDog, mapamp, AaronInSanDiego

      will be happy with some of the changes, I do disagree with your take on the premenstrual disphoria.

      Ah, forget the fact that women have been dealing w/PMS for generations
      While many women have no problems or relatively mild problems around menstruation, there are some women whose severe problems cause them a great deal of difficulty. Just because we've dealt with it for generations doesn't mean we've dealt with it well for everyone.
      This is true of lots of mental problems. Grief and depression after loss of a loved one is normal and doesn't call for medication. But a woman I knew was still in bed all day more than a year after one of her children died and was unable to help her other child deal with his problems and concerns. I pushed her hard to get into therapy and a month later, with the help of therapy and medication, she was still sad, still suffering from loss, but was able to function and be a mother to her surviving child. The purpose of the medication (and therapy) was not to make her happy all the time, but to help her start living her life again despite her totally understandable sadness. And my pushing her came from my own experience of the same kind of loss, not from some pollyannish notion that all grief should be ended with happy pills.

      We're not perfect, but they're nuts! -- Barney Frank

      by Tamar on Sun Dec 02, 2012 at 12:23:17 PM PST

      [ Parent ]

      •  Tamar, you are conflating what I was saying (2+ / 0-)
        Recommended by:
        Anne was here, mapamp

        I also said in the earlier post:

        Serious hormonal issues obviously need to be dealt with biochemically,

        so in no way am I suggesting that people who need medication or therapy not get it. Besides there are many ways to help geniune problems that don't involve taking a pill; many ways to adjust hormones that don't just involve taking a pill.  Pills are not the universal answer. but are being pushed as such.

        You are missing the forest for the trees; you are missing my overarching political point, which is based on day to day medical reality.  And this is what it is:

        1)  From an advertising/pr perspective we are being pushed to be seen as "happy all the time" or not having any aches/pains/anxiety etc. as the new normal, so that we will buy BigPharma's products.  

        2)  Of course, the medical discussion about grief, complicated grief, multi diagnostic grief, post traumatic disorder, dual diagnoses etc. etc. and all other sorts of mental and physical issues are a separate conversation.  Of course these things are real and deserve much attention. But pills are not always the only solution.

        3)  Do you know how insurance companies prefer to treat these psychological (and other physical) problems?  With therapy?  You would be wrong about that.  The insurance companies are making it harder and harder for anyone to get genuine therapy by increasing deductibles and copays, and then hound patient and practioner with demands for 'medical necessity reviews' (just as they do in all aspects of medical practice.)  

        And do you know what they demand of all medical specialities, including therapy: "why isn't this person on medication?"

        INSURANCE COMPANIES ARE PUSHING PILLS FOR EVERYTHING, because it is far cheaper for them.  Whether a person needs it or not.  Pulled a muscle, we won't approve physical therapy, go get a pill.  Sad and grief stricken, take a pill, we won't approve therapy.  And on and on.

        In no way am I slurring therapy, or medication of any sort when really needed.  I am speaking about the effort to normalize us into taking pills from cradle to grave, without a real need.  That is real.  And it is a huge problem.

        What people don't realize is that they won't be able to go to therapy for treatment of their problems.  (Or get a lot of medical procedures.)  Instead, they will be put on a variety of meds.  And it will be justified by the new DSM and the ICD codes.

        Look behind the curtain.

        It is enough that the people know there was an election. The people who cast the votes decide nothing. The people who count the votes decide everything. ~~Joseph Stalin

        by SeaTurtle on Sun Dec 02, 2012 at 01:20:34 PM PST

        [ Parent ]

        •  I agree with part but not all of what you said. (2+ / 0-)
          Recommended by:
          mapamp, AaronInSanDiego

          You're right about the resistance to paying for therapy. My husband's a shrink and insurance companies were requiring constant reauthorization for therapy sessions and all sorts of paperwork that made it really difficult and financially not supportable for him to be an insurance provider (particularly since he devotes half of his time to lower paying clinic job).
          But they're often not so great on medication either. I'll ask him if he gets pushed to put people on medication, but he hasn't said anything like that to me. It might be true.
          and yes -- the TV ads are absurd and are designed to get people to go nag their doctors for various drugs. Doctors weren't happy about it when those ads were allowed to be aired. The promises made during the ads give people false hope quite often.
          Proper use of medication for problems like depression are not designed to make people happy all the time. That's over-medicating and can be dangerous.
          But under-medication is also a problem. My father was a grumpy irritable person for most of his life. He had undiagnosed depression. About 20 years before he died, he talked to my husband about what medication in what dosage might help him. My husband wrote it down and my father took it to his internist. After a few weeks several family members noticed a real difference in him (they didn't know about the medication) and kept trying to figure out why he seemed to be enjoying his grandchildren and life in general so much more. The next 20 years, until his death, were probably some of the best years of his life. My real regret is that my mother wasn't alive to have the pleasure of being with him during that time.

          We're not perfect, but they're nuts! -- Barney Frank

          by Tamar on Sun Dec 02, 2012 at 03:13:52 PM PST

          [ Parent ]

  •  Is their focus becoming more of (4+ / 0-)
    Recommended by:
    HoundDog, whaddaya, 4Freedom, mapamp

    "what people do, not what people are"?

    and what about differentiation of co-morbidity?

    Have you hugged your Boeuf Bourguignon today?

    by wretchedhive on Sun Dec 02, 2012 at 09:06:33 AM PST

    •  Great questions wretchedhive. They go beyond my (3+ / 0-)
      Recommended by:
      whaddaya, 4Freedom, mapamp

      qualifications but maybe some others will comment, I hope.

      I like the idea of it though.  It reminds of advice we got as parents for children -- to criticize or discipline undesirable behavior not label them as bad.  

      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Sun Dec 02, 2012 at 09:43:32 AM PST

      [ Parent ]

      •  Metal to Mental (5+ / 0-)
        Recommended by:
        HoundDog, whaddaya, 4Freedom, Tamar, mapamp
        Gina Putt, of Science Decoded offers us more insights into the changes in the new DSM-V, with a view of how if affects women and other "kinder and gentler" changes, "such as the elimination of 'metal retardation' in favor of 'intellectual developmental disorder.'"
        So Michelle Bachmann will be covered now - right?

        The dire straits facing America are not due poor people having too much money

        by Anthony Page aka SecondComing on Sun Dec 02, 2012 at 10:01:09 AM PST

        [ Parent ]

        •  Yikes Anthony Page. What diagnostic categories (2+ / 0-)
          Recommended by:
          4Freedom, mapamp

          do I qualify for by having the worse proof-reading, spelling, and punctuation skills of anyone on this site?

          The means is the ends in the process of becoming. - Mahatma Gandhi

          by HoundDog on Sun Dec 02, 2012 at 10:14:48 AM PST

          [ Parent ]

        •  Thanks, corrected. Could I ask you about the (3+ / 0-)

          combination of the apostrophe and quotation mark at the end of that sentence?  It looks a little suspicious.  My understanding is that quotation marks within quotation marks get changed to apostrophes. And, the period goes inside of all of them.  But, not it looks like three apostrophes which is stimulating my generalized anxiety disorder as well as aggravating my severe self-esteem and narcissism issues.  

          The means is the ends in the process of becoming. - Mahatma Gandhi

          by HoundDog on Sun Dec 02, 2012 at 10:24:16 AM PST

          [ Parent ]

          •  Haven't a clue (3+ / 0-)
            Recommended by:
            HoundDog, 4Freedom, mapamp

            I was probably blotto on weed during that lesson in 11th grade if I made it to class at all.

            Only recently discovered that there's no such thing as "its,'" actually..

            The dire straits facing America are not due poor people having too much money

            by Anthony Page aka SecondComing on Sun Dec 02, 2012 at 10:32:11 AM PST

            [ Parent ]

            •  Well, you seem to have made it to more classes (3+ / 0-)

              than I did.  Thanks for the catch. I appreciate all feedback on improving my writing. I'm sort of tired of losing readers who think I'm stupid because I don't spell very well, and have some kind of learning disability when it comes to proof-reading.  I can read stuff I've written and somehow my mind corrects them after the photons hit my eyeballs but before they reach the center of my attention.

              My mind also races ahead, while my fingers keep typing, but my fingers try to spell phonetically, and always types you instead of your, and literally dozens of errors like that.  I'm left handed with competing brain hemispheres for dominance issues. which might have something to do with it.

              Thanks again.

              The means is the ends in the process of becoming. - Mahatma Gandhi

              by HoundDog on Sun Dec 02, 2012 at 10:47:38 AM PST

              [ Parent ]

    •  My impression is (2+ / 0-)
      Recommended by:
      HoundDog, mapamp

      that what is happening is mostly a preparation for the next generation in biomedicine, when mental disorders will largely have assigned molecular genetic basis.  And get diagnosed quite high certainty via DNA testing.  Affected people will then likely get not one general lump diagnosis that may or may not get changed over time but a small number of enduring linked and partly overlapping, more useful, sub-diagnoses.

      The new definitions sound a lot more like the pragmatic language used in genetics to describe phenotypes.  There seems to be diminishing or minimal use of abstract philosophical and folk psychological terms and conclusionary terminology.  Of course people will use these in everyday life, but internal professional assessments will gain in descriptive power and predictive accuracy.

      What's missing in the OP, if this is so, is recognition of a diminishing emphasis on episodic/extreme behaviors and more acute attention given to quotidian behavioral differences/difficulties.

  •  Republished to Mental Health Awareness. nt (5+ / 0-)

    "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

    by second gen on Sun Dec 02, 2012 at 10:12:12 AM PST

    •  Thanks seond gen. I guess I should have probably (3+ / 0-)
      Recommended by:
      4Freedom, second gen, mapamp

      published through this group which I think I belong to now thanks to you.  Sorry, I didn't think of it. I have some concentration issues that cause a lot of the world,  common sense, and obvious idea to disappear in my mind when I'm trying to finish a post which is a really big challenge for me.


      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Sun Dec 02, 2012 at 10:17:08 AM PST

      [ Parent ]

      •  No problem. I missed the one you published the (1+ / 0-)
        Recommended by:

        other day. Just got it today. I try to keep up. I don't always do well, either. :)

        "Mitt Romney looks like the CEO who fires you, then goes to the Country Club and laughs about it with his friends." ~ Thomas Roberts MSNBC

        by second gen on Sun Dec 02, 2012 at 04:23:58 PM PST

        [ Parent ]

  •  On the Other Hand (2+ / 0-)
    Recommended by:
    HoundDog, mapamp

    Having a CDKPD diagnosis would allow it to be covered  by insurance.  I'm sick of paying a therapist out of my own pocket to help me deal with CDKPD.

    This aggression will not stand, man.

    by kaleidescope on Sun Dec 02, 2012 at 11:24:09 AM PST

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