DSM-5 and its Evolution from DSM-4

DSM-5 and its Evolution from DSM-4

by Richard Boyd, Body Mind Psychotherapist, Energetics Institute, Perth, West Australia

Copyright 2012

dsmReaders may remember that I recently published an article on the plethora of mental disorder labelling used in the mental health filed. That article titled The Disorder Disorder covered the conflicts of interest and unethical dynamics that have arisen over time within the medical industry in its relationship to the mental health professions. As an update it is worthy to note that in December 2012, the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, was the first significant update in nearly two decades. The old version was called DSM-IV and the new version is called DSM-V or DSM-5. What one notices is the response by APA to the addictions and compulsions people are now having with social media, the internet, gaming devices, and the digital world. For instance there is in Section 3 of the new DSM-5, a mention of a category of disorders needing further research such as Internet use gaming disorder, as well as self harming behaviours which are now reframed as Non-suicidal self-injury. The APA has made major changes to the overall DSM chapter layouts and ordering system so there is a form of clustering of disorders’ based on apparent relatedness to one another, as reflected by similarities in disorders’ underlying vulnerabilities and symptom characteristics. There is a recognition and alignment to the World Health Organization’s (WHO) International Classification of Diseases so there will no longer be two disparate systems of classifications. The changes to the actual disorder classification themselves sees the spectrum of Autistic and Aspergers disorders merged so a person may be told from now on they do not actually have Aspergers disorder but are Autistic in some way instead. This may confuse some clients who are used to old labelling and it will depend on the skill and judgement of the mental health professional to navigate this discussion if and when it needs to occur. There has been some reaction on radio talk back from Asperger sufferers and support groups who have not received this news well. Binge eating disorder is now an official disorder in DSM-5 so many more of the population could now find itself theoretically labelled with this condition. This approach removes binge eating as being seen as a symptom of underlying anxiety and so it will be interesting to see how this treated moving forward. The trend towards labelling “naughty” or disruptive children as having a “real disorder” is now becoming obvious with the inclusion of a new disorder known as the Disruptive Mood Dysregulation Disorder. This serious sounding disorder could apply to a number of children I have met at some stage who went on to grow out of their symptoms with positive parental care and parenting. Consider how your own self or your own children would rate to the categorisation of symptoms under this new disorder: “a child who exhibits persistent irritability and frequent episodes of behaviour outbursts three or more times a week for more than a year”. Apparently this is an attempt to steer the industry away from recent trends to treat and see such children as having a Bipolar disorder. This is where I believe Psychiatry is still laying the groundwork for more and more children to be diagnosed and pronounced as mentally ill when in fact a diagnosis of Parental Deficit Disorder (Poor Parenting!!) may be a better diagnosis and make parents take more responsibility for behavioural outcomes in their children!! Excoriation (skin-picking) Disorder is new to DSM-5 and was previously a symptom within DSM-4 Obsessive-Compulsive and Related Disorders. It looks like I will have to have a few sessions on the couch with my local psychiatrist as well!! Suddenly the DSM-5 net has scooped me up as well as a Hoarder!! The Hoarding Disorder is now a new disorder to DSM-5. My penchant for antiques and old books now sees me join the ranks of the mentally ill!  This disorder seems to pluck people out of an obscure symptom category of those who may have a compulsion to hold and retain objects. According to DSM-5 this classification will help characterize people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behaviour usually has harmful effects — emotional, physical, social, financial and even legal — for a hoarder and family members. This is  real for those whose houses you see on TV filled with rubbish to the roofs in every room and which become inhabitable but many others may find themselves accused of the same problem for where are the clearly defined limits here. It could become a tool of manipulation in legal cases if not left to the most extreme cases. One positive development is the inclusion of the recent advances in trauma Neuroscience and trauma treatments. Posttraumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma and Stressor-Related Disorders and trauma is now being given more recognition overall in the understanding of Disorder formation. DSM-5 pays more attention to bereavement as a trigger to possible mental health disorders such as depression but also how not to confuse the natural grieving process with a diagnosis of depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one. There is a widening emphasis or scope of what constitutes developmental learning disorders in children. The Specific Learning Disorder has a wider symptom cluster to include and represent distinct disorders which interfere with the acquisition and use of one or more of the following academic skills: oral language, reading, written language, or mathematics. This may also accelerate the diagnosis and labelling of some children with a Disorder but will depend on how it is applied in the field by practitioners. The growing societal problem of substance abuse has now seen the confusion with substance use and dependence seen as the same problem in the category of Substance Abuse Disorder substance dependence. In this one overarching disorder, the criteria have been combined and require more symptoms to be present for the Disorder diagnosis to be made. Overall DSM-5 is an evolution of DSM-4 and reflects trends in the mental health fields and new research around our understanding of trauma. The problem still appears to be the need for Reductionistic behavioural symptom breakdown into discrete clusters which become the focus of disorders. In relying on this approach we find the wider set of dynamics of parents, family and environments may be overlooked in the methodology used to understand the appearance of any set of childhood symptoms. The labelling of children as having mental health disorders and the medication of them as a consequence is still a major ethical concern of the whole DSM-5 world. In the constantly emerging, developing, changing and disruptive nature of bodymind evolution of children into adults we can expect some clunkiness in our kids in their behaviours, motor skills, cognitive and emotional skills and developmental levels in the shorter term. We should diagnose, label and medicate only in the face of extensive consultation, analysis, wider family context, and with sensitivity and a plan for remediation when that occurs. Otherwise the quick diagnosis of children and adults as somehow defective, and then the stupefying and suppressive medication of symptoms and emotional/cognitive effect moving forward is a lazy and abusive quick fix that serves no one in finding health and wellness in the longer term. Contact the Energetics Institute for more information about Depression, Anxiety, and other body-mind states of being that affect yourself or someone you love and interact with. Richard Boyd is an experienced Body Mind Psychotherapist and the Director of the Energetics Institute in Perth, Western Australia . Mob : 0407577793 email : r.boyd@energeticsinstitute.com.au www.energeticsinstitute.com.au

Copyright 2015 Richard Boyd

Psychotherapy & Counselling

Private Therapy