The background here is that there's growing concern that bipolar disorder, previously thought to be extremely rare in prepubescent children, is now being diagnosed, inappropriately, in children - specifically in American children. This epidemic of so-called "pediatric bipolar disorder" (PBD) shows no signs of abating.
In response to these concerns, the proposed new fifth edition of the Diagnostic and Statistical Manual (DSM-5) is slated to introduce a new disorder - DMDD. The stated purpose of DMDD is to prevent children getting a diagnosis of PBD - but only by giving them another diagnosis instead.
As I said in 2010 (note, TDDD is the old name of DMDD)
We can all sympathize with the sentiment behind TDDD - but this is fighting fire with fire. Is the only way to stop kids getting one diagnosis, to give them another one? ... Can't we just decide to diagnose people less? Apparently, that would be a rather too radical change...Now, according to the authors of the new paper, if DMDD becomes an official diagnosis, it would only slightly reduce the number of PBD diagnoses - and
If indeed DMDD is a true entity, we suspect that, like bipolar disorder, it, too, will be overdiagnosed.This was based on a study of 82 kids who were admitted to a specialist children's psychiatric hospital. Of the children, 30% met DMDD criteria based on parental report - but only half of those diagnoses were confirmed by observation of the child'd behaviour in hospital. Parents, in other words, over-rated DMDD symptoms. A rigorous DMDD diagnosis would only "save" a minority of children from a PBD diagnosis.
Even in those cases where "DMDD" seems most justified, it's really not clear who would benefit from giving them another diagnosis because they always qualified for 3 or more other diagnoses. Take a look at this table, showing the frankly ridiculous array of "different" disorders diagnosed in 12 children - the ones who were rated most likely to be "bipolar" by parental report -
So even if DMDD is a marginally better diagnosis than PBD - do we really need to give out any more diagnoses to kids like this?
The funny thing is that overdiagnosis of PBD is just about the only concern that the DSM-V committee is responding to at all. There are plenty of other well-publicized concerns: overdiagnosis of ADHD, overdiagnosis of depression... most of these are about overdiagnosis to be honest. Anyway, in those cases, DSM-V is proposing to either do nothing much, or actually expand the diagnostic criteria.
For PBD, they are at least trying, so perhaps they deserve some points for effort.
Margulies DM, Weintraub S, Basile J, Grover PJ, and Carlson GA (2012). Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children? Bipolar disorders, 14 (5), 488-96 PMID: 22713098
16 comments:
My only concern remains will the ICD11 makers find the courage to stop trying to be "compatible with the DSMs?
When will the academic psychiatrists the world over decide to submit papers and attend the World P A meetings and boycot the APA 's one?
I am repeating myself but The USA Americans are good at many things but not at spending wisely their money on psychiatric healthcare.They are were dangerous for the national health care spending and the public health. Full stop.
To suffer the APA taking lead of the academic psychiatric worldwide is no more ludicrous than to ask the China Lawyers and Judges 'sassociation to lead the field on civil right worldwide!
PS: Actually in autism Pr Fred Volkman from yale university and others have published papers indicating that the DSM 5 's ludicrous proposals on autism psectrum disorder will deprive Aspergers on the higher IQ range of their benefits by deying them the DSM stamp of autism.
Well on the plus side, it makes the job for a psychiatrist much easier.
With DSM V in hand everyone suffers from something which is good for business.
Cynical, perhaps. But even shrinks are humans and they also have mouths to feed. Creating a manual that puts half of them out of business isn't very likely to happen, is it now?
petrossa,
If only the psychiatrists and clinical psychologists used the DSMs, the damage will not be so great but judges and school headmasters have been known to possess and use the DSMs.
On the marketing front, the DSMs are masterpieces and the USA Americans are very good at marketing
Ivana, i have a french pill dispenser. Our monthly sessions go like this:
Hi.
How are things"
Fine.
Ok.
(a few minutes silence while i look out of the window)
I don't have much to say actually.
Ok. That's 43.70 Euro
Can i have my prescription please?
Oh yes, here you are.
Bye mister Petrossa. Here is your next appointment.
Not sure which country is the worst. But we are most certainly seeing an ever increasing interest in pathologizing our children.
petrossa,
If I had the priviledge to be your doctor, I would not dare to challenge your expressed views about the incredible benefit you get from your pill.
And I would not even think of it ( I would follow your lead just checking about side-effects regularly).
This because you told us your pills act and relieve you of a terrible chronic suffering state from marked autistic sensorial issues (visual auditoryand may be vestibular hypersensitivities if my memory is functionning.)
You told us that you wished you received those pills younger.
I am not an "antispychiatrist" and I think very badly of those "antipsychiatrists".
On the contrary, I would love Neuroskeptic to tell us the answer of his psychiatrist after his public (here) protesting about o month long only prescription when he declares himself satisfied with his two antidepressants regimen and has no intention to suffer a change on that matter for the years to come.
PS: Some antipsychiatrists are as paternalistic and dangerous as Big Pharma marketing!
Please remember to keep comments on the topic of the post.
neuroskeptic,
When petrossa was right on the topic of ypur post when he wrote:
///Well on the plus side, it makes the job for a psychiatrist much easier.
With DSM V in hand everyone suffers from something which is good for business.///
For, you know overdiagnosis of children makes overprescribing them abd many a psychiatrist has become a pill prescriber.
And you put yourself in the subject of each of your post-charmingly so.
"Suffer the little children" is a must read on the topic of this post of yours neuroskeptic. You might understand why Mr petrossa 's comment was relevant to it.
"suffer the little children" is a post written by Dr Irene Campbell-Taylor, a former Clinical Neuroscientist and Assistant Professor of Medicine at the University of Toronto in Dr David Healy's blog.
http://davidhealy.org/suffer-the-little-children/
Perhaps it is time for me to go back and read Fromm's "The Sane Society" because it seems my society is becoming increasingly insane. A few months ago I read an abstract that started with the claim that up to 20% of USA children have a behavioral disorder that impacts on their academic performance. If that is true the USA has a disaster on its hands. If it isn't true modern psychiatry has a diagnostic disaster on its hands. I hope it is the latter because all the ruckus about DSM V is at least making people sit up and think again what we mean by "mental illness"
The term "mental illness" is in itself suggestive because we don't talk about "leg illness" or "hand illness" but rather about specific conditions. Yet for some reason we choose to lump all those with behavioral issues as essentially being in a group of their own special kind.
On a different level the same problem occurs in psychiatry where we lump together a wide range of symptoms under various headings(shizophrenia, depression etc). We can't define normal behavior so should not expect abnormal behavior to be easily defined. The anti-psychiatrist movement missed this obvious point. They missed a lot of things ... .
When we witness ever increasing numbers of children being diagnosed for behavioral disorders we have to ask whether the children are the problem or whether the world we are creating is the problem.
John,
Thank you so much for your sound comments John.
May be the DSMs shortcomings are just a little symptom of a broader occidental society problem after all...
Hi Ivana,
Talking of fire, just recently I read a text "unshrinking psychosis" wherein the author argues that in some instances(certainly not all) psychosis is actually a type of transition process to a new state of psyche. So while modern psychiatry treats all psychosis as bad, we need to consider that while the experience of psychosis itself is bad, we should not think so much about returning the person to their pre psychosis state but rather move towards a new state.
In your experience Ivana have you seen people who became psychotic, improved, and changed in some significant way?
I have found it very educational to examine the prevalence of various conditions diagnosed among children in the USA by state. Looking at the poor vs rich states (the rich ones have the psychiatrists standing by, no doubt) as the poor are usually the most "labeled". I love to play with the data: http://www.childhealthdata.org/home
Let kids be kids & don't saddle them with pathology when science doesn't know much about childhood BPD.
Thank you for this article.
Jeanette Bartha
Post a Comment