The New DSM
As you’ve no doubt heard by now, a revision of the Diagnostic and Statistical Manual of Mental Disorders is underway. Public comments are being solicited One of the doctors who worked on the last version, Allen Frances, tells Judy Woodruf on the PBS Newshour that the last changes, though well-intentioned, caused an epidemic of overdiagnosis of autistic disorders, childhood bipolar disorder and ADD.
But new changes must be made. As anyone who follows this subject knows, many, many children have been aggressively diagnosed with bipolar disorder, a label that often subsequently confers the blessing of antipsychotics. Antipsychotics, don’t forget, have never been tested on children. We have no idea how such harsh medications affect the developing brain. The drugs increase risk of diabetes, metabolic disorder and tardive dyskenisia — among other mishegas — in adults. God only knows what we’ll discover a generation from now, when these kids are grown up.
So how did we get here with childhood bipolar? There’s a great report on NPR.org you should read in its entirety, but I’ll give you some excerpts:
Since the mid-1990s, the number of children diagnosed with bipolar disorder has increased a staggering 4,000 percent. …
… many of the kids now categorized as bipolar were, once upon a time, diagnosed as having conduct disorder. Kids with conduct disorder are seen as very combative, aggressive, and prone to destructive behavior. But the treatments for conduct disorder are woefully limited, says Carlson. …
Which is why when every day psychiatrists were told that they could now think of this set behaviors as manic-depression, not as conduct disorder, they got so excited, says Carlson. “They thought, ‘Heck, if that’s what it is, we have a bunch of medicines that are supposed to be helpful for mania — maybe I can make it better,’ ” she says. This has deep appeal to doctors face to face with parents who are heartbroken over the difficult time their child is having.
Another advantage to the bipolar label, Carlson points out, is that the insurance industry saw bipolar as a biological or medical problem, while conduct disorder was seen more as a parenting problem, so insurance companies were reluctant to reimburse for it.
“If you’ve got something that says it’s not a medical problem,” says Carlson, insurance is not going to pay for it. “Conduct disorder is bad parenting, lousy environment, poor supervision, you’re a bad seed. It ain’t a medical problem. Bipolar they’ll pay for.”
Finally, Carlson argues, parents themselves were relieved on some level. Because this set of behaviors was no longer seen as conduct disorder, the psychiatrist sitting across the desk from them was no longer blaming them for the terrible things that were happening to their child.
So clearly there are some real advantages to using the bipolar label. The problem, says Carlson, is that because bipolar disorder is understood as a chronic lifelong problem, you really want to be very careful about how you apply it.
“If you have a child who’s got this behavior but you’re not sure how it’s going to evolve, to say to somebody, ‘You’ve got to be on this medication for the rest of your life’ is sentencing someone to something that’s premature. And in the case of some of these medications, where we’re not sure of some of the metabolic side effects; you may be exposing them to a risk that they don’t need to have.”
Of course, many advocates, activists and journalists have been saying for years that the childhood bipolar diagnosis is highly problematic. And there’s been no one more vocal than Philip Dawdy of Furious Seasons. Check his site for his take on the proposed revisions, including the one on childhood BP.
liz | 8:43 PM | Uncategorized
Ha! That kid looks how I *feel* about the new DSM
The “Era of Evidence Based Practices” promised safer and more effective medications, accurate diagnoses, and appropriate treatments yet we now find that many children diagnosed with bipolar disorder didn’t have it and didn’t deserve the label. Who will make these children whole for the price they’ve paid and the price they will continue to pay by virtue of the wrong diagnosis and consequently the wrong treatments?
Liz said it best, “God only knows what we’ll discover a generation from now, when these kids are grown up.” Will too many simply “age out” into the adult mental health system? Afterall, there has been a 25 fold increase in the number of children on SSI by virtue of a MI between 1990 and 2008. This increase wasn’t supposed to happen in the “Era of Evidence Based Practices.” We were told that early diagnosis and treatment was going to lead to superior outcomes and a reduced incidence of disability…. but we have been told so much, so often.
I think part of the problem is that doctors, and what little I know of the DSM itself, fail to stop seeing patients as categories of illnesses, instead of seeing them as individuals. I think another part of the problem is that modern health care, more and more, is being directed not by front-line physicians; but by the pharmaceutical and insurance companies. This endangers everyone, in my opinion, children included.
When drug companies make billions a year, yes billions, from one class of drugs (ie anti depressants) isn’t it convenient to classify an illness to require the drug. Classification of an illness is too linked to use of drugs to cure the illness. The Newsweek article of November 8th showed how the placebo effect of antidepressant drugs is overwhelmingly underestimated. A sad reflection on the use of drugs in both adult and child treatment.
Public Release of the DSM-5 Draft « Neuroanthropology Says:
[...] For specific diagnoses, Dr. Petra has particularly good coverage on the proposed changes in sexual disorders. Liz Spikol looks at the diagnosis of childhood bipolar disorder with a critical eye. [...]
I am a retired psychiatrist and have just published a short and very readable book that places many of these diagnostic and treatment issues into a common sense perspective, although it only deals with adult mental illnesses. The book is “Diagnosing and Treating Mental Illness” by me, John V. Wylie, M.D.
I was not diagnosed with my illness until I was 30 although symptoms were apparent from my late teens. I now see this as a blessing because even though life was difficult I maintained by self-medication a sense of normalcy I have never recaptured. During one of my first stays in hospital a friend said once you were there they put you in a box and there was no way out. My late diagnosis didn’t matter much because the meds than seemed like punishment. My point is every attempt should be made to avoid diagnosing a child with a major mental illness even if symptoms make their lives difficult. For even if meds are now better and the stigma less, the box is still there.
Thank you all so much for writing. When I read that others feel the same way that I do, it gives me hope. I do wish I was diagnosed in my late teens rather than at age 33. I am Bipolar II and a month ago would tell you I didn’t remember, even as a child, being so happy. As you know, that can change and it has. However, as I child I behaved well and on occasion had anger issues but never acted on them. Today, I fear I would be medicated and I wouldn’t have made it socially and intellectually to age 33.
That’s the problem with diagnosis right there. Ronnie says s/he “is” Bipolar II. No, you’re Ronnie, and you’ve been diagnosed with Bipolar II. It is not you and you are not it!
Your remarkable insightful info entails much to me and especially to my peers. Thanks a ton; from all of us.
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