Psychiatry Set to Medicalize Hissy Fits
Every decade or two, the American Psychiatric Association reworks its Diagnostic Statistical Manual, or DSM, to try to have diagnostic categories reflect the current state of theory and practice. Given enormous evidence that we’re currently overdiagnosing things and medicalizing normal behavior, many had hope that the upcoming DMS-5 — the fifth major revision — would show some restraint. We may see it yet — but not if we go down the track described in a post today by neuroscientist, blogger, and DSM watchdog Neuroskeptic. It seems that the DSM-5 may include a new proposed “mood disorder” called “disruptive mood dysregulation disorder,” or DMDD.
If DSM-5 is officially published (it’s due in 2013), kids will be deemed DMDD if they show
“severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.” … at least three times a week.
Do you know any kids like that? If you don’t, then you don’t know many kids. This could be anything, like the meltdown when the shoes can’t be found, the homework got lost, or the braids aren’t quite right. Crimey, I met this criteria last week, just yelling at Karl Rove.
As Neuroskeptic notes, my folk-wisdom skepticism is backed by science:
Pittsburg psychiatrists David Axelson and colleagues have just shown that the DMDD concept is deeply flawed. They took a large sample of kids assessed for emotional or behavior problems, and compared those who would meet the new DMDD criteria, to those who wouldn’t.
“DMDD” turned out not to be correlated with anxiety or mood symptoms in either the child or their parents – rather unusual for a so-called ‘Mood Dysregulation Disorder’ which is found in the ‘Depressive Disorder’ section of the DSM-5.
In fact, DMDD can’t be distinguished from two existing disorders that get wildly overused, “Conduct Disorder” and “Oppositional Defiant Disorder,” which are often used to justify medication for Kids Who Just Won’t Listen. In short, says Neuroskeptic,
DMDD seems to be nothing to do with mood, but instead covers a pattern of misbehavior which is already covered by not one but two labels already. Why add a misleadingly-named third?
Well, the back-story is that in the past ten years, many American kids and even toddlers have got diagnosed with ‘child bipolar disorder‘ – a disease considered extremely rare everywhere else. To stop this, the DSM-5 committee want to introduce DMDD as a replacement. This is the officially stated reason for introducing it. On the evidence of this paper and others it wouldn’t even achieve this dubious goal.
The possibility of just going to back to the days when psychiatrists didn’t diagnose prepubescent children with bipolar (except in very rare cases) seems to not be on the table.
As I’ve noted before, there’s an awful lot at stake in this DSM rewrite. The world is blessed with some really good psychiatrists. I hope I’m wrong in thinking that this DMDD suggests the good ones are not winning enough arguments at the DSM meetings.