Will anyone be normal under new disorder guide?
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An updated edition of a mental health bible for doctors may include diagnoses for "disorders" such as toddler tantrums and binge eating, experts say, and could mean that soon no-one will be classed as normal.
Leading mental health experts gave a briefing on Tuesday to warn that a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is being revised now for publication in 2013, could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.
Citing examples of new additions like "mild anxiety depression", "psychosis risk syndrome", and "temper dysregulation disorder", they said many people previously seen as perfectly healthy could in future be told they are ill.
"It's leaking into normality. It is shrinking the pool of what is normal to a puddle," said Til Wykes of the Institute of Psychiatry at Kings College London.
The DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It is seen as the global diagnostic bible for the field of mental health medicine.
The criteria are designed to provide clear definitions for professionals who treat patients with mental disorders, and for researchers and pharmaceutical drug companies seeking to develop new ways of treating them.
Wykes and colleagues Felicity Callard, also of Kings' Institute of Psychiatry, and Nick Craddock of Cardiff University's department of psychological medicine and neurology, said many in the psychiatric community are worried that the further the guidelines are expanded, the more likely it will become that nobody will be classed as normal any more.
"Technically, with the classification of so many new disorders, we will all have disorders," they said in a joint statement. "This may lead to the belief that many more of us 'need' drugs to treat our 'conditions' - (and) many of these drugs will have unpleasant or dangerous side effects."
The scientists said "psychosis risk syndrome" diagnosis was particularly worrying, since it could falsely label young people who may only have a small risk of developing an illness.
"It's a bit like telling 10 people with a common cold that they are "at risk for pneumonia syndrome" when only one is likely to get the disorder," Wykes told the briefing.
The American Psychiatric Association did not immediately respond to a request for comment.
The scientists gave examples from the previous revision to the DSM, which was called DSM 4 and included broader diagnoses and categories for attention deficit hyperactivity disorder (ADHD), autism and childhood bipolar disorders.
This, they said, had "contributed to three false epidemics" of these conditions, particularly in the United States.
"During the last decade, how many doctors were harangued by worried parents into giving drugs like Ritalin to children who didn't really need it?," their statement asked.
Millions of people across the world, many of them children, take ADHD drugs including Novartis' Ritalin, which is known generically as methylphenidate, and similar drugs such as Shire Plc's Adderall and Vyvanse. In the United States alone, sales of these drugs was about US$4.8 billion (NZ$6.68 billion) in 2008.
Wykes and Callard published a comment in The Journal of Mental Health expressing their concern about the upcoming DSM revision and highlighting another 10 or more papers in the same journal from other scientists who were also worried. DSM 5 is due to be published in May 2013.
- Reuters
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Hmmm.... I don't know about the "false epidemic" with regards to Autism... The most commonly diagnosed form of autism these days is Asperger's Syndrome, which was only officially recognised in the 90s, and that recognition has been of huge help to a large number of people who were previously just tossed to the side, and labelled as "freaks" - or, in the school system, as just plain "naughty". From the inside, I can tell you that we're just trying to get by as best we can... If we survive the school system, then we tend to be fairly productive members of society, and that's far more likely now that teachers are obliged to recognise that we're not all completely homogenous, and that persecuting certain students for being a bit different is no longer acceptable.
And let's face it... When it comes down to being called a "freak" or being called "autistic"... Well, I've been called both plenty of times, and I know which I prefer :P
All this allows is for everyne to be able to blame somehting for their problems, "its not be its my disorder that make me late for work" when are we going to wake up and take responsibility for our actions and stop trying something or someone to blame!
This scares me. As I'm still young (and possibly naive to the way it works) but from memory, every "disorder" I was diagnosed with was usually followed by a bill for drugs. If there's all these disorders for issues that arise in our lives being added to the DSM then is it possible that costs for drugs (that are not really needed) going to come back to the patients? As was mentioned with the Ritalin costs being 6.68 billion for kids that didn't need it. The sad and also disgusting topic in my own opinion is how EVERYTHING in today's day and age HAS to be labled with a reason. When a child has a temper tantrum it doesn't mean they have a disorder. It could mean that their parent said "No, you can't have that chocolate". When a teenage girl becomes sad because her boyfriend broke up with her doesn't mean she has clinical depression. For some sick reason we have to say they do just to try and fix it, sadly (from my experience) with drugs and treatments. I accept that there are mental conditions out there. But seriously. When will everyone realise that the only reason these small issues are treated as disorders and big problems is because those in the position to influence say that they are big things. If you had two paths and a doctor told you to go down one and a paper delivery boy told you to go down the other which would you go down?
Nick #4, you don't have to eat that much to maintain weight. To maintain I eat around 2400 calories a day. Someone who is obese and sedentary could eat the same as me and maintain their weight.
Food addiction? Sounds like a cop-out for fat people.
You should rather say "you shouldn't let your family over-eat".
The more labels and 'disorders' we have in the DSM, the more opportunities there are to sell drugs to us that may or may not make us better. This 'chemical imbalance' theory is taken for granted as fact when it is not the case (google chemical imbalance).
I would love to see an investigative piece on the publishing of the DSM and the profits of the drug companies. It's probably the only true causal relationship in this whole thing.
Nick, I think you are missing the point. Regardless of binge eating being good or bad for you, or people using food as a coping mechanism, I think it is taking it too far to say those who binge eat have a mental disorder! It is normal to eat, exercise, smoke, clean or do something when we are anxious or stressed. Just because someone has a vice that is food does not mean that they are mentally unwell and need to be medicated to live a normal life! Humans do things all the time which not necessarily good for themselves - this is not to say they should be treated as having a disorder - it's normal. I think this article makes a very fair point - there are too many mental 'disorders' that are being medicated. Do we forget that we are human, and imperfect, and as such we have emotions and anxieties and fears and feelings that are sometimes not ideal.
Eating disorders are already in DSM-IV
So, having a disorder is the new "normal".
This article is highly biased. The DSM V, still in development, is also aiming to reduce ambiguity so people who need help as they are in distress can get help. Nick, you are right that it is definitely time binge eating is included, however binge eating and obesity are not one and the same. Phil, the medical profession can only do what it can within the confines of governmental restrictions and funding.
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Do you ever have difficulty getting to sleep?
Must not get angry, even when provoked Must not get anxious, even when under stress
Eat, but only from the bottom of the food pyramid Drink, but don't get drunk Enjoy sex, but not too much