Some Initial Thoughts On The Draft DSM-5
As many of you know, a draft of the proposed DSM-5 is just out and it’s bound to stir plenty of comment and controversy. First, I’ve got to congratulate the DSM-5 crafters for making the draft public and for seeking public comment. That’s right: the APA wants to hear from members of the public, not just medical professionals. So let them know what you think.
Meanwhile, let me offer some preliminary comments:
1. Internet addiction isn’t included, which is fine by me and likely will save the APA much sniggering and criticism.
2. Bipolar disorder type 3 or subthreshold bipolar disorder is not included either and that is definitely a victory for critics like me who’ve long held that the softening of mood disorders–such as with bipolar disorder type 2–has led to millions of Americans being overdiagnosed and overmedicated.
3. Perhaps the biggest losers in the politics of DSM-5 are the Harvard child psychiatry crew and the FDA. The Harvard folks have pressed hard for over a decade to establish mood lability and temper tantrums in children as pediatric bipolar disorder or child bipolar disorder. Harvard’s Joseph Biederman and others claimed they had nothing but sound science driving their claims, ones the FDA bought hook, line and sinker. This all led to the wild overdiagnosis and overmedication of millions of American children, basically to shut them up when arguably they needed more attention to their diets and lack of physical activity.
Now, the DSM-5 authors have not included PBD in their proposal, certainly giving the lie to the Harvard crew. Instead, they chose to label these kids as having Temper Dysregulation Disorder with Dysphoria. While anything that steers diagnosis and treatment away from meds first, last and always is to be welcome, I cannot help but feel that slapping a syndrome of any kind on children is dangerous. Especially since the new syndrome is describing behavior that’s been around for eons and hasn’t been particularly troubling for humanity until child psychiatrists and pharma companies got their hands on all of this in the 1990s.
I’ll have more to say on this one as the implications become clearer.
4. Advocates for including psychosis prodrome have won a victory as the DSM-5 draft contains a disorder called Psychosis Risk Syndrome. The research on all of tis is quite slim and such research as exists hasn’t pointed to a high percentage of youngsters allegedly at-risk of developing a full-blown psychotic disorder as being readily identified by precursor symptoms. And those who recall the disastrous PRIME study will remember that medicating teens sure didn’t help them out. I hope this proposed diagnosis is promptly dropped from inclusion in DSM-5.
5. I’ve not been able to poke into the newfangled, proposed severity scales for anxiety and depression, so that’s something I’ll have to push off until later. You can see an example here, however.
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