| T O P I C R E V I E W |
| alexis |
Posted - 06/11/2013 : 06:27:45
Hi all,
For anyone following the mainstream psych diagnoses of these disorders, the DSM-5 has been out a couple of weeks now with the new "Somatic Symptom and Related Disorders" category (replacing Somatoform Disorders).
While a lot of people discover somatic illness theory through Sarno and similar popular authors, it's good to remember that this is a pretty well established field that's been studied for well over a hundred years with a lot of ongoing research. It's really essential, therefore, to at a minimum be familiar with the categories and terms used by most of the psychological community.
Alexis |
| 20 L A T E S T R E P L I E S (Newest First) |
| altherunner |
Posted - 06/12/2013 : 21:50:58
OMG, love your abbreviations. drop in again, TTFN! |
| alexis |
Posted - 06/12/2013 : 20:12:21
quote:
Originally posted by pspa123
http://psychcentral.com/blog/archives/2012/01/07/why-psychiatry-needs-to-scrap-the-dsm-system-an-immodest-proposal/
It's hard to disagree with that guy's basic argument that one shouldn't treat the DSM as a bible, but other than researchers who need a standardized population I doubt many in practice do (the author himself recognizes this). Perhaps if a separate set of research categories is developed as proposed by the NIMH that will allow the DSM to experiment with formats that might be able to worry less about the research value and be more "practical". It remains to be seen what that would mean, however. |
| pspa123 |
Posted - 06/12/2013 : 18:07:00
http://psychcentral.com/blog/archives/2012/01/07/why-psychiatry-needs-to-scrap-the-dsm-system-an-immodest-proposal/ |
| alexis |
Posted - 06/12/2013 : 17:27:39
quote:
Originally posted by pspa123
So you dismiss the critique in the New England Journal of Medicine?
I read the article and it looked like they were commenting on a different revision, but without the exact text of the proposal from a year ago I can't really tell what they are looking at. If you have a comment on the actual publication version I'll look at it. |
| pspa123 |
Posted - 06/12/2013 : 17:14:34
"As I mentioned before, psychologists, counselors and social workers all use this same system and they don't (with a couple of very small exceptions) write prescriptions."
And how often, do you think, they refer to doctors who do? I have seen this myself on multiple occasions. |
| alexis |
Posted - 06/12/2013 : 17:12:21
quote:
Originally posted by pspa123
Lots of things are problems. That does not make them psychiatric disorders with a diagnostic code, treatment plan and prescription. If you don't believe there is a difference, then we should just agree to disagree because our philosophies are irreconcilable.
The DSM is a diagnostic manual; it does not include any recommendations for treatment.
"DSM-5 is a manual for assessment and diagnosis of mental disorders and does not include information or guidelines for treatment of any disorder. That said, determining an accurate diagnosis is the first step toward being able to appropriately treat any medical condition, and mental disorders are no exception. DSM-5 will also be helpful in measuring the effectiveness of treatment, as dimensional assessments will assist clinicians in assessing changes in severity levels as a response to treatment. "
http://www.dsm5.org/about/pages/faq.aspx#7
As I mentioned before, psychologists, counselors and social workers all use this same system and they don't (with a couple of very small exceptions) write prescriptions. |
| pspa123 |
Posted - 06/12/2013 : 17:10:50
So you dismiss the critique in the New England Journal of Medicine? They are not exactly Mother Jones.
"Unfortunately, the effect of this proposed change would be to medicalize normal grief and erroneously label healthy people with a psychiatric diagnosis. And it will no doubt be a boon to the pharmaceutical industry, because it will encourage unnecessary treatment with antidepressants and antipsychotics, both of which are increasingly used to treat depression and anxiety.
Nor will this change help practitioners deal with the common dilemma presented by the bereaved patient with mild depressive symptoms — the question of how to tell whether such a patient is heading toward major depression or should be left alone to grieve. The answer is often not clear after a first visit, in which case a period of watchful waiting is reasonable. If the symptoms persist or intensify, a diagnosis of clinical depression becomes more likely."
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| alexis |
Posted - 06/12/2013 : 17:09:09
quote:
Originally posted by pspa123
The two month window was in fact removed.
Yes, because a person can be grieving and depressed. The footnote still states that normal grieving, which is considered a minimum of year if you check Persistent Complex Bereavement, is similar in appearance but not the same thing. All they did was remove the hard time frame requirement and offer flexibility in diagnosis. If you check the note it makes specific reference to the varied cultural norms for distress in recognition that this is a diverse experience and may be longer for some, shorter for other cultures. I could argue both sides of having a time frame and I would certainly not jump to judge either as an effort to diagnose the bereaved with major depression. |
| pspa123 |
Posted - 06/12/2013 : 17:02:40
Lots of things are problems. That does not make them psychiatric disorders with a diagnostic code, treatment plan and prescription. If you don't believe there is a difference, then we should just agree to disagree because our philosophies are irreconcilable. |
| alexis |
Posted - 06/12/2013 : 16:59:16
quote:
Originally posted by pspa123
To me the very words, Intermittent Explosive Disorder, are absurd. Some people have a bad temper. That does not rate them a psychiatric diagnosis, in my ever so humble opinion.
This category was designed to address a prototype situation where a man loses job after job because he explodes in meetings or to the boss and is concerned about his now ruined career. Do you think that is a problem? A disorder? That some changes in the criteria are needed, or do you just dislike the name? |
| pspa123 |
Posted - 06/12/2013 : 16:58:58
The two month window was in fact removed. |
| alexis |
Posted - 06/12/2013 : 16:56:46
quote:
Originally posted by pspa123
Grief and depression in DSM 5.
http://www.nejm.org/doi/full/10.1056/NEJMp1201794
The actual DSM-5 is out and published. It's a lot safer to reference the actual publication rather than a description from a year ago of what some people had proposed, as much was proposed and changed over that time. |
| pspa123 |
Posted - 06/12/2013 : 16:43:14
To me the very words, Intermittent Explosive Disorder, are absurd. Some people have a bad temper. That does not rate them a psychiatric diagnosis, in my ever so humble opinion. And whether or not Mother Jones is reliable, the interviewee said what he said and as the author of DSM IV I think his opinion is entitled to consideration. |
| pspa123 |
Posted - 06/12/2013 : 16:36:36
Grief and depression in DSM 5.
http://www.nejm.org/doi/full/10.1056/NEJMp1201794 |
| art |
Posted - 06/12/2013 : 15:43:54
When I was a psychology student back in the stone age, we were already laughing at what was then the DSM 3 I believe. Homosexuality by that time was no longer an official psychiatric disorder, but most people thought of it as one. If one were looking for something emblematic of the arrogance and wrong-headedness of the psychiatric profession, one need look no further than their approach to gay patients back in those days, and well beyond in many cases.
It was around that time I read Thomas Szasz and I began to understand the fundamental illogic of treating "disorders" of thought and behavior as if they were actual physical illnesses. Of course, that has added resonance for us mind/body explorers.
Anyway, I think it's safe to say that the practice of psychiatry has caused more misery than it has relieved.
I hope someday we will be taking a more practical approach to mental health (we should always bear in mind we're talking metaphorically here. It's easy to get mixed up otherwise.) by talking more about happiness and fulfillment and its lack, rather than in terms of illness and symptoms...So many people in the world are unhappy. I think it's the price of modernity. It's not people who are sick nearly so much as our false and alienating materialistic society. |
| alexis |
Posted - 06/12/2013 : 12:03:27
By the way, it's stated in the Mother Jones article that the NIMH has renounced the whole DSM system. Here, in fact, is a quote from the official NIMH statement from which you can see they did no such thing. I used to get Mother Jones way back in college, but it's hardly an objective resource and has a definite axe to grind.
quote:
Today, the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH's Research Domain Criteria (RDoC) project website states, "The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated."
http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml
One thing I do agree with, however, is that publication should not be the responsibility of the American Psychiatric Association, and if that doesn't change I think it likely it will be replaced eventually, either by the RDoC, which will have its own political and agenda problems, or by the IDC, which is almost identical to the DSM at this point (something to consider when blaming the US political and cultural climate for the structure of the DSM).
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| alexis |
Posted - 06/12/2013 : 10:02:37
quote:
Originally posted by pspa123
In my opinion, like that of the eminent psychiatrist whose article I posted, DSM 5 (if not its predecessors) turns many normal conditions into disorders/illnesses. Like kids with temper tantrums (intermittent explosive disorder), people who are grieving, and so on.
In the brave new world of DSM 5, everyone will get a diagnosis (or several) and a script. 10 percent or more of teenage boys are on stimulant medication already, how great is that?
Normal grieving isn't a disorder in the DSM-5 and "Uncomplicated Bereavement" continues to be listed as a V code only (used for reference, research and billing, as often people come for counseling after a death or are grieving but also are visiting a providor for another reason to which it is relevent). Normal grieving is not only not considered a disorder, but is explicitly listed as an exclusionary criteria from diagnosis in several disorders to be sure people aren't mistakenly misdiagnosed when only grieving. Are you objecting to something regarding the thesholds or talking about the theoretical discussions that took place before the DSM-5 was published?
Intermittent explosive disorder only applies to people over 6 or at an "equivalent developmental level". Are you saying you think this age threshold is too young or that even adults with these behaviors don't have problems? That age specifier was added to clear things up in this edition, so maybe you are referring to an older edition? Note that even for kids over 6 this isn't diagnosed if they have an adjustment disorder (another good topic for debate) such as might occur with a recent move or divorcing parents.
For ADHD I'm inclined to agree it's overdiagnosed, though the DSM-5 actually tightens criteria for kis in some areas (though the age of onset is raised). This seems to be the most controversial diagnosis in the DSM, but I'm not sure whether we really want to remove it or just tighten the criteria or treatments. ADHD diagnoses are highly predictive of other behaviors and problems and this is more than just a diagnostic issue. Is there a particular criteria you'd change or would you want to see the whole category dropped? |
| pspa123 |
Posted - 06/12/2013 : 07:59:51
In my opinion, like that of the eminent psychiatrist whose article I posted, DSM 5 (if not its predecessors) turns many normal conditions into disorders/illnesses. Like kids with temper tantrums (intermittent explosive disorder), people who are grieving, and so on.
In the brave new world of DSM 5, everyone will get a diagnosis (or several) and a script. 10 percent or more of teenage boys are on stimulant medication already, how great is that? |
| tennis tom |
Posted - 06/12/2013 : 07:40:10
If it's not already in the new DSM 5, it should be, "PSYCHOBABBLE DISORDER" :
http://www.thefreedictionary.com/psychobabble |
| alexis |
Posted - 06/12/2013 : 07:21:45
pspa123,
I get that you and many people think there's a problem with saying a lot of people have mental disorders. What I want to know is why you think that's a problem. Is it because these things really aren't "disorders"? I think that's arguable, but you have to make a list of the one's you would address. I have picked a couple hoping to get your opinion but you don't seem interested in that discussion.
Or do you have a problem with it because, as you have previously referenced, it is a non-neutral term in some ways. If that is the case we aren't talking science but politics. How do you think a mild "disorder" like caffeine withdrawal is different from twisted ankle? What is your argument for skewing language over educating the populace to understand the terminology? |
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