Difficulties, Diagnoses, the DSM.

In a New York Times Op-Ed piece from today, one of the leads on the DSM-IV (the “Diagnostic and Statistical Manual”, the current edition of an industry standard tool for mental health, primer here) task force wrote about the upcoming changes in the DSM-V (likely to be released in early 2013).  Summarizing, Allen was suggesting in part, “…after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription.”, and that the American Psychiatric Association was  arguably no longer in a place to be singularly in charge of the meting out of diagnoses, calling it a “monopoly” (offering that an agency akin to the FDA or National Institute on Mental Health might be examples of ways to provide oversight in the efforts to insure some science around diagnosing emotional and mental problems).

Am with Allen on quite a bit of this.  What comes to me often too, is that we have equally large fish to fry with the DSM and the profession than just the pathologizing and monopolizing he suggests.  We have been over-diagnosing ADHD (attention deficit hyperactivity disorder) and bipolar disorder, among others.  Our differential diagnosis (rationalizing one diagnosis vs another) has also been resulting in much harm to people by way of treating issues unneeded, and/or incorrectly.  We are also arguably guilty as a discipline of using interventions that are more “intrusive” than necessary (for instance, medicating a problem before efforts at traditional talk therapy and/or other interventions have yet to be tried).

It seems to me that in reviewing the DSM, we are more currently in need of insuring the accuracy and value of our diagnoses, in terms of insuring that those so suffering are treated more appropriately.  We do know ways to treat depression, anxiety, addictions, bipolar disorders and etc.  We do have means of helping people through grief/loss, communication problems, abuse, suffering with stress and etc.  As the saying goes though, the “cure” (a dubious word to begin with) is only as good as the diagnosis, and with the numbers of the diagnosed only increasing in the US year after year, either our diagnosing or treatment (or maybe a bit of both) are not faring as well as they might.

A quick aside here- not all of the missed treatment opportunities are about the above issues.  Some of them are due to the influence of Big Pharma (an intense imposition by the pharmaceutical industry), access and funding of mental health treatment, the insurance industry and more.

Specifically related to the DSM though, my hope is that we’d simply be better at a lot of the material we already have.  Adding diagnoses, or simply separating them into finer and finer constellations of symptoms seems both unnecessary and unhelpful, philosophically speaking.  Part of what I’m getting at above is that I think we have some good ideas about how to help many ills- I just wish we spent more time treating them, and less time diagnosing new ones.

1 Comment (+add yours?)

  1. Petar Sardelich LMFT/PT/MAC
    May 14, 2012 @ 18:15:58

    Quick addendum to this post: on “Medpage Today” ( http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/32575 ), there was an article referencing a UCLA study about diagnoses and children. For the previous 30 years, the most common diagnoses for children were respiratory illnesses. But looking at 2008-2009: “Asthma and breathing problems had dropped to sixth, they reported in The Future of Children, published by Princeton University and the Brookings Institution.

    After speech problems, the most common disability diagnoses in 2008-2009 were:

    Learning disabilities (affecting 1,775 out of 100,000 children, accounting for 23% of all cases of disability)
    Attention deficit-hyperactivity disorder (1,715 per 100,000, or 22%)
    “Other mental, emotional or behavioral problems” (1,452 per 100,000, or 19%)
    “Other developmental problems” (779 per 100,000, or 10%)”

    That reads to me that between 22 and 41% of children have been diagnosed with ADHD or other behavioral problems (considering the possibility for multiple diagnoses).

    Reply

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