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Diagnosing Mental Disorders: “We made mistakes that had terrible consequences”

Are psychiatric diagnoses valid?  I'm beginning to wonder.  At best, they are sometimes misapplied to the point of becoming meaningless.  At worst, they are causing great harm both psychologically and physically.

Bipolar Disorder, Depression and the DSM

The DSM is the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and establishes the criteria by which mental disorders are diagnosed.  It is recognized not only by the psychiatric community and the insurance community but by the general public as well.  Let me state up front, I'm not a psychiatrist nor am I an expert on the DSM.  I am a therapist.  But my profession and the clients it serves are greatly affected by both psychiatrists and their diagnoses. 

I have argued before that bipolar disorder has become overdiagnosed to the point that anyone with "mood swings" is being diagnosed with it. 

There is currently a debate over the up and coming DSM-5 which is becoming quite heated.  Why is this book so important?  Because it establishes the criteria for labeling someone as being "mentally ill".

In their December 2011 issue, Wired Magazine posted an interesting article discussing the now forming DSM-5.   The current version is the DSM-IV-TR, DSM, version four, "text revision" from 2000.  Allen Frances, lead editor of the fourth edition says it contained serious errors.

“We made mistakes that had terrible consequences,' he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs."

What does this mean to the general public?  An epidemic of children diagnosed with bipolar disorder.  Bipolar disorder has, since the publication of the DSM-IV become the diagnosis du jour.  I see everyone with "mood swings" being diagnosed with and treated for bipolar disorder. 

See:  "Mood Swings are Normal"

With the already problematic DSM IV TR causing overdiagnosis of these major illnesses, I have a serious concern about the proposed DSM is the change in how they view depression vs. grief.   The current manual advises doctors against diagnosing a client with depression if their symptoms could be better accounted for by bereavement.  What does this mean?

The symptoms of bereavement and depression can look a lot alike;  lack of appetite, lack of sleep, apathy, lack of energy, sadness, loss of appetite, loss of interest and difficulty working.  If a client has recently lost their spouse of 30 years and comes to their doctor complaining of symptoms ressembling depression the doctor would likely rule out depression (a mental illness which theoretically requires medication) in favor of bereavement (which is normal).  He might refer for brief counseling if the bereavement is complicated and interfering with the client's functioning.  But the client would not be labeled "mentally ill".     

It is proposed for DSM 5 that the bereavement exclusion be removed.  So anyone presenting to their doctor with symptoms of depression/bereavement would not be screened for bereavement.  They would simply be diagnosed with depression. 

See also:

"The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations."

"Children, Psychotropic Medications and Death"

"Another 'ADHD and Bipolar Child' - Not"

"Overdiagnosing Bipolar Disorder"

 

 

Comments

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Jonsi Jones

This is helpful to me and relevant to something going on in a loved one's life right now. Thank you!

DreamingTree

I often tell patients that the diagnosis doesn't matter as much as the symptoms. From there we can focus on development of positive coping skills to address the individual's needs.

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