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The next edition of the American Psychiatric Association's diagnostic bible will lead to millions of healthy people being labeled with a mental disorder and treated with potentially dangerous drugs, some psychologists say.
They've drawn up an online petition urging the group to reconsider adding a number of diagnoses to the fifth edition of the Diagnostic and Statistical Manual (DSM-5), to be published in 2013.
Among the disorders the petition calls "unsubstantiated and questionable" are "apathy syndrome," "Internet addiction disorder" and "parental alienation syndrome."
The petition, posted Oct. 22, now has more than 5,000 signatures, says David Elkins, president of the Society for Humanistic Psychology and professor emeritus at Pepperdine University.
Most additions aren't supported by published scientific research, he says.
Children and the elderly are particularly vulnerable to being mislabeled with a mental illness, he says. For example, the DSM-5 proposes adding the diagnosis "mild neurocognitive disorder," which could lead doctors to prescribe medication to older patients experiencing the normal age-related decline in mental ability.
One of the most outspoken critics of the proposed changes is psychiatrist Allen Frances, who chaired the task force behind the last update, in 1994.
Psychiatric medications "are very useful when used appropriately," says Frances, professor emeritus of psychiatry at Duke University.
But, he says, the DSM-5 proposes about a dozen "really bad" changes that could lead to over-prescribing.
"They are all tremendously well-meaning," Frances says of the DSM-5 task force members, both psychiatrists and psychologists. "They are not doing it because they are in bed with drug companies. What they are totally naïve about is how the things in the book are transformed in actual practice."
Frances and Elkins are calling for an independent scientific review of the proposed changes in DSM-5.
It is the first to be developed in the Internet age, so the public has been able to read drafts and post comments online at DSM5.org.
On Friday, the task force posted a response to the petition. Some newer diagnoses, it says, are still being tested in "field trials" at academic centers and in "routine clinical practice settings" by psychologists, social workers, counselors and psychiatrists.
The task force will open the website for public comment one final time next year, according to the posting.
Posttraumatic Stress Disorder
Obsessive Compulsive Disorder
Hoarding Disorder
Skin Picking Disorder
Generalized Anxiety Disorder – 1) change of the proposed name from Generalized Anxiety and Worry Disorder to Generalized Anxiety Disorder; 2) change of the number of symptoms in criterion C (i.e., put all 6 symptoms from DSM-IV back to criterion C); 3) some minor wording changes
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Voice Disorder
Expressive Language Disorder
Communication Disorder Not Otherwise Specified (now diagnosable under Language Impairment umbrella category)
ADHD
Phonological Disorder (now Speech Sound Disorder)
Stuttering (now Childhood Onset Fluency Disorder)
Stereotypic Movement Disorder- criteria and severity scale updates
Eating Disorders
Eating Disorder Not Otherwise Specified (being renamed Feeding and Eating Conditions Not Elsewhere Classified) – added descriptions of several conditions of potential clinical significance
Mood Disorders
Premenstrual Dysphoric Disorder
Bipolar I Disorder – Current or Most Recent Episode Hypomanic
Bipolar I Disorder – Current or Most Recent Episode Depressed – changed criteria A to include at least 3 major symptoms of Major Depression of which one of the symptoms is depressed mood or anhedonia
Bipolar II Disorder – Current or Most Recent Episode Hypomanic – separated from Bipolar II Disorder – Current or Most Recent Episode Depressed
Personality Disorders
Antisocial Personality Disorder
Levels of Personality Functioning
Schizophrenia and Other Psychotic Disorders
Catatonia Specifier – changed disorders this specifier applies to
Delusional Disorder
Brief Psychotic Disorder
Schizophrenia – changed criteria A; removal of reference to Mixed Episode
Substance-Related Disorders
Addition of new Substance-Induced Disorders criteria pending
Disruptive Mood Dysregulation Disorder
Oppositional Defiant Disorder
Conduct Disorder
Avoidant/Restrictive Food Intake Disorder
Mixed Anxiety Depression
Originally posted by rubbertramp
damn, i match so many of those there's gotta' be a rubber room
with my name on it somewhere.edit on 17-11-2011 by rubbertramp because: (no reason given)
As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.
Our panel tried hard to be conservative and careful but inadvertently contributed to three false "epidemics" -- attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many "patients" who might have been far better off never entering the mental health system.
The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day -- despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.
The manual, prepared by the American Psychiatric Assn., is psychiatry's only official way of deciding who has a "mental disorder" and who is "normal." The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two. If requirements for diagnosing a mental disorder are too stringent, some who need help will be left out; but if they are too loose, normal people will receive unnecessary, expensive and sometimes quite harmful treatment.
Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status -- to say nothing of stigma and the individual's sense of personal control and responsibility.
What are some of the most egregious invasions of normality suggested for DSM-V? "Binge eating disorder" is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) "Minor neurocognitive disorder" would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as "major depression." "Mixed anxiety depression" is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.
The recklessly expansive suggestions go on and on. "Attention deficit disorder" would become much more prevalent in adults, encouraging the already rampant use of stimulants for performance enhancement. The "psychosis risk syndrome" would use the presence of strange thinking to predict who would later have a full-blown psychotic episode. But the prediction would be wrong at least three or four times for every time it is correct -- and many misidentified teenagers would receive medications that can cause enormous weight gain, diabetes and shortened life expectancy.
Originally posted by Ghost375
Originally posted by rubbertramp
damn, i match so many of those there's gotta' be a rubber room
with my name on it somewhere.edit on 17-11-2011 by rubbertramp because: (no reason given)
How do you know you match so many when the symptoms aren't listed?
Originally posted by Ghost375
Not to mention that most disorders are only disorders if it causes negative effects in someone's life.
In other words, if these things aren't causing a problem in your life, then you won't be diagnosed with a disorder.