Bipolar or TDD? Asperger's or autism spectrum?

Proposed changes in psychiatrists’ diagnostic manual could introduce “new mental disorders,” reports the Washington Post.

Children who throw too many tantrums could be diagnosed with “temper dysregulation with dysphoria.” Teenagers who are particularly eccentric might be candidates for treatment for “psychosis risk syndrome.” Men who are just way too interested in sex face being labeled as suffering from “hypersexual disorder.”

Asperger’s Syndrome and autism could become “autism spectrum disorders,” a change opposed by many Asperger’s advocates.

Advocates say the new categories are more precise. Critics say people in normal distress will be misdiagnosed, put on medication and stigmatized by insurance companies.

Among the concerns are proposals to create “risk syndromes” in the hopes that early diagnosis and treatment will stave off the full-blown conditions. For example, the proposals would create a “psychosis risk syndrome” for people who have mild symptoms found in psychotic disorders, such as “excessive suspicion, delusions and disorganized speech or behavior.”

“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.

“Temper Dysregulation with Dysphoria” is intended “to counter a huge increase in the number children being treated for bipolar disorder by creating a more specific diagnosis,” the Post reports. But some fear it will encourage unneeded treatment of moody kids.

In addition to classifying the symptoms of grief that many people experience after the death of a loved one as “depression,” the proposals include adding “binge eating” and “gambling addiction” as bona fide psychiatric conditions; they also raise the possibility of making “Internet addiction” a future diagnosis.

The American Psychiatric Association will listen to feedback before deciding on the proposed changes for the new diagnostic manual, due out in 2013.

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  1. I thought that men being “just way too interested in sex” defined normal men!

  2. Diana Senechal says:

    Once while copyediting a scientific book on the savanna of Brazil, I came across the term “Late-acting Self-Incompatibility” (applied to certain plants). I thought it would be a funny name for a human disorder, so I wrote a story “The Diagnosis” around it. Now it doesn’t seem far-fetched.

  3. There is a great video on you tube called “severe autism when there is no answer” The video is made by a man with Aspergers.

  4. I know that there are alot of people for this new diagnosis and others that are not for it. However I will tell you that my son is now seven years old and we have been shuffled from every imaginable doctor to find out what was ” wrong” with him. One said he had Asperger’s another said ” no, it’s behavioral” and yet another, “bad parenting”. But from a mother of a child that has been labeled ” Bi-Polar” with ADHD and placed on medication that doesn’t seem to do anything except cause concern for his little body, this comes as a MAJOR relief. Just maybe I will be able to find the help for my baby without all the medication, the many doctors visits from state to state, and just maybe I will be able to learn to make his life better. The way he is now is just sad and I have known for along time he was misdiagnosed, but as a parent what can you do? I think that this may very well be the best thing that could have happened for many children in my sons position.

  5. Dia–I am with you. Arriving at the correct diagnosis, to guide the right treatment, is such a trying process. In my own son’s case, there were so many sidelines diagnoses. And we were up against the “behavioral” and “bad parenting” labels many times. Under pressure from school, I accepted a (somewhat premature) diagnosis of ADHD and medication for the same. The results were disastrous. While the school saw some improvement, I saw the disastrous fall every night as he was “coming down” from his meds. Some at school even found some perverse sense of justice in this (“now you see what we have to go through”). After a (supposedly thorough) psych eval, meds were removed. Next, based on symptoms, medication for depression, with moderate short-term improvement. Meanwhile the school district moved him twice (looking for a more appropriate “program” that could “handle” him). No one (but me) was ever concerned about the school-induced trauma of so many rejections and moves–and whether they might be having an impact on a kid with a diagnosis of depression.

    In the end it took a tragic summer in which two very competent summer programs (one a very high-priced program for kids with all kinds of disabilitis) rejected him as too difficult (meanwhile the agency providing our mental health case-management–responding to the fact that I was worried about losing my job due to all the crises and lack of child care–thought I should do more “networking” to build support) and he ended up in a residential treatment facility. Even then, the misdiagnosis continued and he stayed on medication that is known to trigger bipolar episodes of mania. When I started reading, it was like a light bulb. I approached our psychiatrist and asked for an evaluation at a local facility that was doing research in childhood bipolar.

    As a parent, I have still had to fight to maintain that diagnosis. At one point, we had a new psychiatrist who told me point blank that she did not believe in childhood bipolar. Fortunately we only saw her once–but the primary child behavioral health agency in our area still tended to see every child referred to them as having ADHD.

    I think we sometimes have a tendancy to become cheerleaders for the recognition of the diagnosis that fit for us. That is not the point. What is the point is to allow sufficient flexibility to allow for the correct diagnosis for every child–so that the left-overs don’t automatically get tossed into the latest basket.


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