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Some Docs Hope to Call Tantrums 'Mental Disorders'

dsm-5-revisions-apaThe American Psychiatric Association has proposed dozens of changes — including pathologizing some temper tantrums — in its first attempt in 15 years to overhaul its diagnostic manual.

Revisions to the Diagnostic and Statistical Manual of Mental Disorders, a kind of bible for modern psychiatry, have far-reaching consequences, especially with regard to who gets diagnosed as mentally ill.

Among the changes:

A proposal to create a new condition, “temper dysregulation with dysphoria,” to diagnose and treat children who throw too many tantrums. TDD would be a new category within the Mood Disorders section of the manual. The aim of this change is to help clinicians differentiate between bipolar disorder and severe mood dysregulation. Critics argue a TDD entry would encourage over diagnosis of children, not discourage over diagnosis of bipolar disorder, as the APA argues.

“They are close to treating the children like guinea pigs. I think that’s appalling and outrageous,” said Christopher Lane, author of “Shyness: How Normal Behavior Became a Sickness.” “The APA should be moving to prevent such controversial practices, not encouraging them, as it is doing here.”

They’ve also proposed officially moving Aspergers syndrome into the broad category of autism spectrum disorder. Until now, it had been diagnosed separately from autism, though experts have long referred to it as high-functioning autism.

Posttraumatic Stress Disorder in preschoolers may also get added to the manual, and also a conduct disorder for children who show a lack of empathy for others, remorse for doing something wrong or concern for bad grades.

The APA also wants to add “risk syndromes,” which supporters hope would lead to diagnosis and treatment before a full-blown condition develops. For example, “psychosis risk syndrome” for people who may exhibit, according to the Washington Post, “excessive suspicion, delusions and disorganized speech or behavior.” Detractors fear, however, these risk syndromes could saddle people unnecessarily with a pre-diagnosis (and treatment) for just being wacky.

From the Post:

“There will be adolescents who are a little odd and have funny ideas, and this will label them as pre-psychotic,” said Robert Spitzer, a professor of psychiatry at Columbia University, who has been one of the most vocal critics of the DSM revision process.

If all revisions are adopted, binge eating will now be a mental disorder, alongside anorexia and bulimia; grief after the death of a loved one will be diagnosed as “depression”; and a higher than normal sex drive may be considered a disorder.

Changes to the DSM are huge and sweeping. They determine what gets researched and how people see themselves and others. They influence everything from the law to government programs and business. Depending on the outcome of health care reform, these changes could also determine whether some people can get insurance at affordable rates — or at all.

The APA is taking comments on the proposed revisions until April 10 this year, followed by more research. A final revised DSM-5R is expected to come out May 2013.

What do you think of the changes? Would this have helped someone in your family? Or do you think they will do more harm than good?

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