Amazing how politicized the DSM has become. Pseudo-scientists, witch doctors and snake oil salespersons all vying for a piece of the lucrative pharmaceutical industrial complex pie.

So skewed and corrupt the entire process has become, that it even has hard critics of the DSM reduced to treating every new edition like a score card, "We got that one excluded, but PRS stays in, a victory on Mental Case Nutbar Syndrome for the Harvard school, but no to Internet Addiction, and a hard line drive for Bipolar-7 but but, foul ball!... batting 500, not bad....."

They are getting rid of mixed states and possibly bipolar NOS, both of which I presented with. Now all episodes will just have a possibility of "with mixed features" tacked onto the end. That makes some sort of sense, but not a lot. I've also seen that the rating scales are really clever, and will probably be a HUGE help to doctors to help with diagnosing issues. When it comes to NOS, they are gunna switch it to another name. Now I'll be Bipolar CNEC (conditions not elsewhere classified) with either Insufficient information, subsyndromal, or other tacked on. What a mouthful. I always find looking up your diagnosis in the DSM to be fascinating.

How and where does one comment on the DSM? I can't wait to give them a piece of my mind.

Oh, they are adding Non Suicidal Self Injury as a diagnosis outside of borderline personality disorder. That is actually SMART. I am a former self injurer who almost got labeled BPD instead of BD because of the self injury. That would've changed a lot of things for me.

It's all very interesting to me. I'm glad they are revising the DSM but I hope they look at other treatment methods other than psych meds. I just posted today about my annoyance and frustration with psychiatry and particularly with child psychiatry, based on our family's experiences. I'll tell you though not medicating your child when they have been given a psychiatric diagnosis is unpopular in the mommy blogging world. No matter what they might say, mommies like to medicate their babies and they don't like people pointing out that it might not be necessary.

Just another way to start drugging them younger and younger, those terrible 2's and childhood temper tantrums will now be license for psychiatrists to drug them up, and shut them up!

It's an assault on children, wasn't Rebecca Riley's death shocking enough?!!! It's all about a drug industry, hell like the DSM-V authors don't have their hands in the cookie jar!

The inclusion of Asperger's into the "autism spectrum" seems like a pretty big deal, I'm surprised it wasn't mentioned. This will likely cause a bit of a tussle given the perceived stigma the a-word carries and the wide, wide spectrum of functionality the spectrum will now encompass. Plus, what about PDD-NOS diagnoses previously thought to be Asperger's-lite? Are they autistic?

I rather think the name for the spectrum should be changed entirely.

Several years ago, I wrote a satirical piece on adding a new diagnosis with these criteria: irritability, frequent crying, grimacing, refusal to eat and sleep, etc. Naturally, people with this new diagnosis would need to be drugged aggressively, to be sure to fix the broken brain responsible for these behaviors. Since this new disorder was so prevalent, screening should take place in all mother and baby health visits and other venues of convenience: parks, supermarkets, etc. This would generally correspond to teething in babies about 6 month old and ongoing. A massive market overlooked.

I agree this is somewhat of a victory as far as "child bipolar" goes.

However the absolute arbitrariness of most of the criteria is striking.

Additionally the last criteria, in my opinion, negates the whole diagnosis together because what can better account for this type of behavior than "temper dysregulation disorder with dysphoria" ? hmmm......

... I can think of a lot.

How about ' the urge to slap a psychiatrist on the head syndrome' or ' post-paxil very pissed off at being duped syndrome' , personally i think that it would be an idea that psychiatrists just make the new DSM a kind of fill in the blanks yourself type of book.. Maybe also they could make a pop up version for kids with a free anti- psychotic flavoured lollipop? The kids could just diagnose them selves and make it all up as they go along, because that's what the psychiatrists are doing anyway, now wouldn't that be ' inclusive'... ? I can't wast until this piece of grandiouse fiction hits the shelves.. I could do with some funny toilet roll...

Michele (or anyone), do you know what category they're placing the Non Suicidal Self Injury in? My first reaction, without knowing any specifics, is that i don't see how self-injury can be any sort of diagnosis; in my mind it's a symptom, that is a signal of distress and/or poor coping, although i have known of folks who develop something of an addiction to it.

While i agree that it's a good idea to clearly separate self-injury from BPD, i find it rather pathetic that the proposed solution to the misuse of one diagnostic category is... to create another diagnostic category! Rather than saying, "Attention, doctors! Please stop abusing the BPD diagnosis." Can't they hold a workshop? (The only time that diagnosis has ever been raised with me is after i've disagreed with the practitioner about my diagnosis or the course of treatment. Which, first of all, tells me some practitioners can't tolerate disagreement and need to rationalize it away by deciding i have a "disorder" that makes me "difficult". And second, it gives me a glimpse of the kind of prejudicial attitude borderlines must have to deal with, and from clinicians, no less! Which is awful.)

That Psychosis Risk Syndrome scares the crap out of me; i'm sure i'd have been diagnosed with that at some point in my early twenties. Practitioners were always looking for signs of psychosis or previous molestation, again i think because of the self-injury. They can't prophylactically medicate someone they think MIGHT become psychotic _in the future_, can they?

The mixed anxiety depression thing; i fall into this category, and have been mistakenly diagnosed with bipolar because of it (although how the fuck this man got from one to the other... this argument got me one of my BPD diagnoses). So, it's probably valid, but it irritates me, again, that they would need to combine two commonly co-occurring diagnoses just because psychiatrists can't recognize that these two things often co-occur.

I don't see premenstrual dysphoric disorder. Did they scrap it?

I remember seeing an advertisement for fluoxetine specifically for the treatment of PMDD, a couple years ago; they even gave it a different brand name. And more recently, if i remember correctly, the birth control pill Yaz was advertised for that purpose. Can they do that? Advertise a drug for treatment of a disorder that's not in the DSM?

Interesting and diverse comments on the proposed changes in DSM-V. In my view, this is much ado about nothing and hardly represents justification for a revision, but because it's been 16 years since the last one (if one excludes DSM-IV TR, which one should), it's long overdue. However, the paucity of amendments really demonstrates though how little progress has been made in the field of diagnostic research. Unfortunately, a profound regression has actually occurred in this area because we have the proverbial tail wagging the dog...big pharma in collusion with academic psychiatry in creating pseudoscientific diagnostic checklists, such as the mood disorder questionaire, to expand the prevalence of bipolar disorder 10 fold in as many years, thereby causing an accompanying demand for treatment. One day, it will take an innocent child like Rebecca Riley, God rest her soul, to inform the grown-ups that the emperor has no clothes.

Why on earth wasn't NBPD included? You know, "Nemeroff-Biederman Personality Disorder," which is a variant of NPD ("Narcissistic Personality Disorder"? NBPD is quite virulent, and encompasses the most malignant forms of aggressive narcissism and self-aggrandizement, such that they harm children, patients, institutions, and others under their spell. This is a horrible oversight!

They put Non Suicidal Self Injury under both "Disorders commonly diagnosed in childhood" and "Mood disorders", I believe. I know they put it in the former for sure because that is where I found it. An odd place to find it for sure, but it is true that it starts yound. I started at 12.

I seriously doubt that children already carrying the diagnosis of bipolar disorder will find themselves correctly diagnosed or undiagnosed. Afterall, many of us who grew up in the children's mental health system know that a diagnosis once given is less a label then an indelible tattoo.

Joseph Biederman is certainly not a loser. He had years of sun and fun with the pediatric and childhood bipolar diagnoses. It is the children who are the losers and they will bear the burden of misdiagnosis, consequent inappropriate treatment and the stigma. And to think all of this happened during the putative "Era of Evidence Based Practices."

If you step back from the rhetoric for a moment, you can recognize what the controversy is about: namely, the concept of who's "ill" and who's "normal."

You must agree that there are REAL and OBVIOUS cases of severe mental illnesses out there: paranoid schizophrenia, melancholic depression, mania with psychosis, OCD, etc. These have been diagnosed since DSM-I and will continue to be diagnosed for as long as humans roam the earth.

The problem, though, is when the "illness" part can be disputed (e.g., dysthymia, bipolar II, personality disorders, "anxiety," many cases of ADHD, virtually all childhood diagnoses except autism & mental retardation, etc.). Instead of simply recognizing the diversity of mankind and helping people adjust to their personal quirks, the pharmaceutical-psychiatric complex has found it necessary to synthesize new diagnoses (which then, of course, become new markets).

And patients aren't innocent either: people generally want to blame their troubles on a disease for which they can simply take a pill.

Why can't we go back and treat the patients who are truly suffering, and who really need our help? Oh wait, not much money in that...

Please read my paper "Prognosis Negative".Those who find this subject of interest should enjoy it. http://www.mentalhealth.freeuk.com/article.htm

This is from NPR

"But it will take some time to determine whether psychiatrists and psychologists will actually change their ways.

"I don't know what they'll do," said Dr. David Shaffer, one of the psychiatrists on the DSM-V childhood committee that is behind this change.

"Maybe the practitioners will be such firm believers in it that they'll continue to use [bipolar]."

http://www.npr.org/templates/story/story.php?storyId=123544191&ps=cprs

This is from the DSM-5 site

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=397

Temper Dysregulation Disorder with Dysphoria

The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.

WITH that in mind, I wouldn't consider this a wash out of the childhood bipolar dx, in fact what my thoughts were when I read about it, is that it will give license to a BROADER spectrum of symptoms, the docs won't give up the bipolar label that easy, and it's already approved for payment treatment for insurance companies...temper dysregulation also is applying to the under age 10 bracket....so all of the drugs that are currently being FDA approved for age 10 and up (such as Abilify and Risperdal)will be readily available for those 10 and up bipolar kids who OUTGROWS TDDD.

It's all about profit, and this book revision committee is still allowed to receive $10,000 per year of industry income, plus unrestricted grant income until the book is published.

$10,000 of industry money can still influence the researcher/revision author, and wouldn't it be interesting to watch what companies the adolescent member group gets there 10K from? wouldn't you bet it will be the makers of Abilify, Risperdal, Zyprexa, Seroquel?

It's just opening the door for drugging off-label under age 10 temper tantrums that happen a few times a year in 2 settings....

HOW you can comment on the DSM-5?

GO HERE to the Dsm-5 development site, register and comment.

After reading Steve's comment, i think i am finally beginning to understand Sally's point from our conversation a couple months ago, on why she disagrees with the medicalization of psychotherapy. Lightbulb-in-brain.

Now, i don't know how people would pay for therapy if they couldn't go through insurance and make it into a "medical" thing. But this is the practical vs. the idealistic. Practically speaking, i like the idea of people's bills getting paid; ideally, i like things to make sense.

Even for people who suffer from some widely-agreed-upon legitimate diagnosis (schizophrenia, bipolar), i think there is going to be some adjusting-to-life aspect of the therapy. Obviously the process of coping with a mental illness has unique difficulties that a person without mental illness doesn't face... but does that make their adjustment process qualitatively different from that of a person who is not mentally ill? Where do you make the separation?

Thanks Michele for the response, and thanks everyone for your patience as i sort out my thoughts in writing!

Here's the revision "rationale" for weeding out which kids are TDDD and which are Bipolar:

"One possible way to identify and study those with short duration episodes is to include them as a specific sub-subcategory within an improved Bipolar Disorders Not Elsewhere Classified (BD-NOS) category." page 8/11

PDF DSM-5 revision rationale 11 page report

Specific Sub-subcategory? what a joke, this dx isn't going anywhere!