Anyone paying attention knows that the forthcoming DSM-5 guide book for psychiatrists been getting plenty of advance criticism.
Because this medical volume influences very non-medical factors like insurance coverage and definitions of mental “health,” exactly who gets classified and in what manner can have huge material and social consequences. The new DSM will redraw the lines on conditions ranging from autism to transgender identity. As Slate reports today, yet another diagnosis is drawing fire:
“Nothing burns the critics worse than “Disruptive Mood Dysregulation Disorder,” a new diagnosis for kids 6 to 18 years old who three or more times a week have “temper outbursts that are grossly out or proportion in intensity or duration to the situation.” It actually started out as “temper dysregulation disorder with dysphoria” (tantrums, plus you feel bad) but got changed so as not to openly malign tantrums. But the diagnosis still focuses on them, and critics say it is so broad and baggy that it’s ridiculous—and dangerous. Duke University psychiatrist Allen Frances, who chaired the revision of DSM-IV in 2001, says the DMDD diagnosis “will turn temper tantrums into a mental disorder.” In a recent blog post at Huffington Post, Frances put DMDD at the top of his list of DSM-5 diagnoses we should “just ignore,” because “a new diagnosis can be more dangerous than a new drug.” Clinical social worker and pharmacist Joe Wegmann called DMDD a diagnosis based on “no credible research” that would help drive a “zealous binge” of overdiagnosis.
“Is the outcry legitimate? Or are Frances and Wegmann just having themselves their own conniption fit? DMDD’s defenders say they actually hope the new diagnosis will slow a growing tendency to misdiagnose troubled, disruptive kids with bipolar disorder. Since 2001, the rate of bipolar-disorder diagnosis among children and teens has jumped more than 4,000 percent (that’s right, times 40), despite controversy over whether bipolar disorder even occurs in kids. Bipolar disorder often gets treated with combinations of antipsychotic and mood-stabilizing drugs (lithium and Risperdal, for instance) that have strong side effects, and it carries a huge stigma and attendant effect on self-image. At first glance, DMDD seems a decent alternative. Thehallmarks of a pediatric bipolar diagnosis, for instance, center largely on hyper-arousal, hyper-reactivity, and hyper-irritability—in other words, irritable kids who get excited and overreact, perhaps by having tantrums. A kid who scores high in those areas, and whose parents or teachers have trouble dealing with the behavior (or act in ways that exacerbate it), might get pegged as bipolar, with the sad outcome of taking powerful and questionable drugs and carrying a troubling label. DMDD, its advocates say, offers an alternate diagnosis that would carry less of a stigma and less likelihood of drug treatment.