<p>This article does not include the diagnostic criteria, and the “critic” ignores them as well. It’s simply false that “grief,” “temper tantrums,” etc. are now diagnosable conditions. Most grieving people and most kids having tantrums won’t fit the criteria. Irresponsible, stupid article for equating common terminology with the diagnostic labels. They aren’t the same.</p>
<p>Agreed, Hanna. I’m sure there are plenty of people being misdiagnosed by overly zealous or dishonest psychiatrists responding to pressure to give people recognized labels. That doesn’t mean the DSM is to blame. Everyone in my family is prone to anxiety. I’m the only one who, at one point in my life, regularly had trouble sleeping at night because I literally thought that my heart palpitations (almost certainly caused by the anxiety) were likely to kill me before morning. Thankfully, that was a brief period of my life - because I was diagnosed with GAD and got the help I needed. </p>
<p>A good doctor will recognize the difference between normal and pathological manifestations of otherwise similar behavior.</p>
<p>I also noticed that anybody who speaks frequently about anxiety is more prone to it. What if we did not know that such thing exists? What if we just use our natural human responses like if something is bothering you, you naturally avoid it. I am sure there are many things (and they are different from person to person) that bother every single one of us. I certainly have many and I cannot explain them. I am afraid of heights. My reasction is way beyond any normal reaction, I have physical sensation of fear in my knees and I guess, my face turn green. Anyway, it is obvious to others around me without me scomplaing. Lots of other things are bothering me, they create that fear that cannot be explained. So, I suppose I can go to the doc. Isn’t it easier just to avoid situation? There are other people who we cannot tolerate, and we do not know why. Isn’t easier to avoid theri company as much as possible? I cannot imagine single person who is completely anxiety free. So, we all have to take drugs? I do not see any logic in this solution.Drugs are for heavy duty reasons. For person with Schizophrenia, who cannot funciton without drugs, they are unavoicable. For all kind of kiddis attention disorders, I would not allow my kid to take any of them, they are simply dangerous. Others have to decide to themselves and their kids. No sleeping pills for me personally, I rather function on 3 hours of sleep, just get used to it, not a biggy.</p>
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<p>You take drugs when avoiding something or someone interferes with your ability to enjoy or have any quality of life. The threshold is different for everyone. I don’t think you have any idea of the number of people who are agoraphobic, despite being on psychiatric drugs and doing all kinds of therapy, CBT, DBT, etc. This is the sad part of it all. Through my own research, I’ve basically learned there are psychiatrists who are comfortable prescribing benzos, and psychiatrists who refuse to prescribe them. Guess what, not every person responds to the SSRIs, SNRIs, etc., and in fact, they can have their own list of severe side effects and discontinuation syndromes. My psychiatrist was at a psychopharmaceuticals symposium sponsored by Harvard last winter, and came away with the message that the benzos are definitely being underused because physicians don’t know how to prescribe them, or don’t want the responsibility of managing this class of drugs in their patients. </p>
<p>Yes, I’m up on my soapbox. It upsets me to no end that insurance companies basically call all the shots when it comes to treatment. It puts physicians and mental health professionals in the place of always feeling like big brother is looking over your shoulder. As I’ve begun to share slowly in some other threads, I am in my own insurance coverage hell hole right now after a very bad year. The insurance companies ordered discharge from a partial hospitalization program (M-F 9-2:30) because they didn’t think I met their criteria, despite the fact I had basically become agoraphobic. I don’t want to be agoraphobic; I want my life back like it was before 9/2011 when I wasn’t on four different psych meds, but the insurance company kicks and screams along every step of the way as I pursue treatment options. Some they cover, some they don’t. Unfortunately, it’s the really intense, expensive programs that they won’t cover. Insurance companies would rather someone be on drugs and functional, rather than taking the time and energy for talk therapy because it’s cheaper to prescribe and cover a medication than pursue psychotherapy.</p>
<p>OK… down off my soapbox (for now).</p>
<p>I just don’t want the pendulum to swing too far the other way - yes, some people NEED drugs. That’s the only way my 20-year-old is able to stay in school, and even then it’s a daily struggle for him. He has schizoaffective disorder under DSM-IV, but I think that will be different in DSM-V. My middle son has bipolar disorder and ADHD - yes, I believe that’s an accurate diagnosis for him. Unfortunately, the doctor hasn’t figured out the right meds for him.</p>
<p>I was in the “Just buck it up” camp before mental illness hit our family. Please don’t judge others until you’ve walked in either their shoes or their parents’.</p>
<p>MaineLonghorn - </p>
<p>excellent post, especially the last sentence.</p>
<p>Did I say the same in post #23: "For person with Schizophrenia, who cannot funciton without drugs, they are unavoicable. " for person who cannot be at the top of Empire state building (and similar situations, which might involved enxiety about exam) drug might mean impairment for the rest of their lives because they never had a chance to learn how to cope, the skill that everybody has to develop without a drug and development of this skill is possible only under certain amount of stress. No stress, no way of learning hoe to cope with it.</p>
<p>From what I can tell…The final version doesn’t come out until May 2013. Many categories have been made into inclusive diagnoses rather than being a stand alone diagnosis (some previously stand alone categories are now listed as mild, moderate, severe form of an over-all diagnosis). Seems like some categories (addiction/use) have been included/enlarged to allow physicians to diagnose and get paid by insurance companies–no comment on that.</p>
<p>Miami, I wasn’t targeting you, just opinions I have heard expressed in general. My middle son, though, does have ADHD, which does not fall in the schizophrenia/bipolar spectrum.</p>
<p>^And I am very sure that if I took my S at certain age to certain doc., he would be diagnosed. The little guy just beat up everybody who slighly offended his friends and had complete disregard for any rule, believe me I was at every lunch forced to watch him by school at some period of his life. And I was suggested to take him in, I just did not. I believe that most boys (and some girls) are going thru this because they cannot cope with hormone changes. I have met very normal kids (at least by my measures in comparison to my own) who I was told by others are on drugs, well, then how do they learn? I would never get it. How they can learn to deal with their emotions if they are not allowed to experience them? Can anybody explain that, I am darn stupid here. IMO opinion if one is to learn, he has to be given a chance to learn.</p>
<p>Diagnosis is a difficult process. How many have read some “here are the seven signs of _____” and said yeah, that’s me! ? All of you? Seems to be so far!
I’m not a psychologist but I’m pretty sure that the great majority (at least I hope so) of people who land at the doctor’s doorstep feel the need to be there. I just hope the physician at that doorstep is able to determine the severity of the case and what needs to be done either talking therapy or meds.</p>
<p>MiamiDap–With all respect, I think the “buck it up camp” (as MLH) put it is really the wrong route. Sometimes kids need support through therapy and possibly meds that a parent can’t provide.</p>
<p>I do respect the fact that it is every family personal decision and nobody else’s business. However, if you consider entire population, the whole population is way over-drugged for mental and other (physical) reasons. So, if you look at statistics for entire population, the drugs are definitely abused, so there is no concern for “buck it up camp” as this camp is way outnumbered by 'gimmy this drug and gimmy it now or why did I visit you, doc" group, there is no question, it is very well known fact.</p>
<p>Not sure that’s true since I don’t have the facts.</p>
<p>Why are most of the things listed called “disorders”? Just because humans possess neurodiversity doesn’t mean that everyone with a neurological trait that differs from the mean has a “disorder”.</p>
<p>Where did you get the idea that all neurological traits that differ from the mean are labeled disorders? Definitely not from reading the DSM.</p>
<p>At any rate, the fact that something is highly prevalent in a population doesn’t mean it’s not a problem. A large majority of adults have tooth decay, but it’s still a disease that needs treatment. The day may be coming when the majority of U.S. adults have type II diabetes, and it won’t stop being a disease just because most of us have it.</p>
<p>However, there’s a difference between definitions of tooth decay and diabetes, and many psychological disorders.</p>
<p>The first two have objective, observable manifestations. Tooth decay isn’t voted on; you have it or you don’t. It’s observable; no one debates whether a tooth has decay or not. Diabetes is,admittedly, defined in that the number which actually indicates disease might be debated or re-set, but the manifestations of active disease are not–the mechanism by which changes in insulin and blood sugar lead to complications such as kidney failure, heart disease, vision problems, etc, are well-understood and clear.</p>
<p>Much psychological definition is purely by aggregrate decision–a group deciding to draw a circle “Here” and label this “Disorder X” by consensus. Which is why a manual is necessary and updated regularly; as the consensus changes, different traits are grouped, labeled, and classified as disorders, or not.</p>
<p>This is not to say that disorders don’t exist, just that it seems to be that there is something way more subjective about their parameters than there is with much physical disease (though some of those are not well-understood, either.)</p>
<p>The DSM has been a football for a long time, it ebbs and flows in terms of what is diagnosable and so forth. The right wing is still out their crying because being gay was removed from it 40 years ago, and all kinds of once treatable ‘issues’ like being into certain forms of sexuality were removed. </p>
<p>From what I know of the DSM (I am not a therapist or psychologist, just used them) it doesn’t seem like psych people use that to diagnose people, it seems more like a book where you can code what you are treating people for and get it paid for by insurance companies, and that what goes in there may reflect lobbying by certain groups (like health insurers) that favors conditions you can med to death, while de-emphasizing ones that use talk therapy (put it this way, despite the fact that talk therapy has proven itself to be in many cases as effective as meds, psycho-pharm is the way to go with the insurance companies from everything I can tell). </p>
<p>Sometimes having something in the DSM is really problematic. Transgender people have been debating including gender identity disorder in the DSM (which it has been, not sure about DSM V), because in reality it isn’t a mental disorder per se, it appears to be from what I can tell simply how the person is wired, and no therapy can ‘cure it’, therapy is there to help them make decisions about what they need to do…the debate is that putting it in there stigmatizes them (much as having homosexuality in there did), as being ‘mentally ill’, but if you remove it, it makes getting treatment for it covered by insurance difficult if not impossible (not that many insurers cover help for transgender folks anyhow, but for example, the limited plans that cover the surgeries and hormones could back out if it isn’t in there)…</p>
<p>And yes, it is problematic because sometimes fads do get in there, a kid having a tantrum is not diagnosible IMO, since most kids at one time or another do (not to mention adults) and the question about being in the DSM always seemed to be if the behavior in question affected the person’s ability to function. A kid throwing a temper tantrum seems more lilke a behavioral isssue and/or a power struggle with the parent, not a condition.Someone being overweight is not necessarily a mental illness, the person who binge eats may have another condition (like depression) that causes them to do it, but in of itself, may only be true of someone who compulsively eats with no other reason behind it. I always look at childhood issues with a jaundiced eye (I am not talking things like autism), it always seems to be that people want to find a convenient, easy answer in something like ADHD rather then bothering to look at the root causes, which often I think are not what it seems (for example, stats consistently say that about 85% of the kids tagged with ADHD don 't have it, that often they are kids who are naturally active, or kids in school who are really bright and bored to death, but get tagged with that because it is easy as diagnose, pump em full of ritalin and they are 'cured…not just making that up, someone did a study of kids tagged with ADHD, and a lot of them were out there on the IQ scale and such…)…the therapist I used often said that most kids who come in for childhood psychology don’t need the help, it is the parents…</p>
<p>Again, from the therapists I have worked with, what they said was the DSM was not a “Bible” in the sense that you followed it rigidly, that most of what they did combined their clinical training with their own experience and the DSM just gave a framework for them to start with or use as one of many guides. Unfortunately, it is trying to code something difficult to code, human behavior being what it is, and it is imperfect and flawed, and more importantly, you have health insurance companies who use it as a bible, as if it is all that matters.</p>
<p>I teach one “regular” class in an affluent school in which - no exaggeration - over 75% of the students have at least one psychiatric diagnosis (mainly ADD our ADHD). The remaining kids could probably have one if their parents were so inclined.</p>
<p>While I’m all for diagnosis and treatment of illness where possible, we have, IMHO, gone too far.</p>
<p>Kids get accommodations for negative behaviors, and, in many cases, this does not help then to manage their own symptoms effectively and learn effective, non-pharmacologic coping techniques.</p>
<p>If they’re getting accommodations, as opposed to medication, those accomodations should be geared toward teaching to manage their own symptoms. My oldest D was diagnosed as ADHD (borderline) and Oppositional Defiant in 3rd grade. She had a 504 plan with accommodations - most of which ended up benefiting the whole class. In most cases, these were just ideas that improved the teaching, but which were otherwise not implemented - things like having the homework written on the board in a specific spot, so she could copy it down accurately, rather than it being dictated when she might or might not be paying attention. By 7th grade, we dropped the 504 plan because she had learned to manage her own negative behaviors. Do we still have issues sometime? Yes, but she has learned to cope better, and we as parents have also learned what does and doesn’t work.</p>
<p>Fast forward to now, where our middle D is struggling. Since 6th grade, some of her teachers have felt she was lazy, neglecting to do the work for their classes. But it turns out she doesn’t read well - even though she tests above her grade level in reading. They wouldn’t test her, so I finally had her tested late last year. When I finally got the report, I found whoever had responded to the questionaire sent to the school railroaded us, and influenced the report. Fast forward to this year, and she has finally met with our reading interventionist who say she is fluent, but has very low comprehension - she can read anything you put in front of her, but she won’t understand it. Apparently this is rare, but not unheard of, and the DSM gives the school psychologist something to work with. If she doesn’t have “something” they can’t designate her as special ed, and they won’t get state assistance to give her appropriate accommodations. No state assistance means they can’t afford it, and she doesn’t get the help she needs.</p>
<p>It’s really not all that different from physical ailments - look at asthma. I have exercise induced asthma, but exercise wasn’t recognized as a trigger when I was a kid. D has stress as a trigger - every time she cut a molar as a toddler, she ended up hospitalized, struggling to breathe. Other D has a visual disorder related to sensitivity to light. It was not diagnosed by a doctor or optician, but it is very real. She wears colored filtered lenses, and the difference in her reading fluency in obvious. Thankfully, the glasses are an accommodation that doesn’t cost the school anything, so they are in her 504. One of her teachers wouldn’t allow extra time on his assignments until the 504 went through, because it wouldn’t be fair to everyone else who might like extra time. No diagnosis - no accommodations.</p>