APA's new diagnostic manual: Asperger's Disorder to be Dropped

[danceronice]

I think TV has a lot to answer for with this one as a recent trend seems to be to glorify the mentally ill as somehow more astute than the rest of us as if their mental illness somehow opens their mind to secret creativity the rest of us are too conventional to tap into. We have Monk who is supposedly OCD but it's presented as this cute quirk and it really doesn't prevent him from having a full life (I've never seen his skin bleed from too much washing). Then there's that new show that I couldn't bare to watch after one episode where a schizophrenic decides to go off his meds so he can be a better crime fighter.

Setting aside Monk's been over for at least a year, considering he lost his job because of his obsessive behaviors (and some more resembling paranoia than compulsions) and required a PA to function outside the very tightly-controlled conditions of his home, I wouldn't say it was entirely portrayed as a 'cute quirk.' Especially as it was played as initially a high-functioning situation made severe (ie the needing help to leave the house and stay calm, the need for consistent talk therapy with a professional) by his wife's murder and some of the obsessive behaviors stemmed from maintaining her things exactly as they were. OCD is not strictly a disorder where someone washes their hands until they bleed (hand-washing may not even be one of the behaviors.) Ritual and repetitive behaviors can become destructive without needing to be 'doped to the gills' to get out of bed in the morning. IOW, TV may not be accurate (I think the trend of making light of and/or glorifying sociopathy is probably a lot more destructive) but your sister's case is not a typical example of an OCD patient, either, but rather an extreme one. Some obsessive and/or compulsive patients can learn to function without medication and still have a legitimate problem.

[jlai]

UGG - I don't think you're crazy, either. I do have concerns with ASD being diagnosed at such a young age. If you already have services, why is there a need for diagnosis at this age? Does it make a difference to the services you receive? .

Not sure how people get services without a diagnosis (formal or otherwise). Early intervention is key in such cases, so I'd say, the earlier the better.

[Angelskates]

Not sure how people get services without a diagnosis (formal or otherwise). Early intervention is key in such cases, so I'd say, the earlier the better.

UGG's child is already getting IE without a diagnosis.

[judiz]

Thank you mattTheViking. LOL-I did not mean to sound defensive. I just know it is somewhat "controversial" (for lack of a better word) to get your kid tested before two. I am just very very scared it sucks.

My son was tested when he was still an infant, I knew in my heart there was something not right with his development and I am thankful everyday I was strong enough to insist on seeing neurologists and specialists and not just be labelled as a nervous mom. When my son was diagnosed, I was just so thankful there were people out there who could help. He's 16 now and looking forward to getting his first car and going to college in 2014. My son will always have challenges due to his disability but when I think what could had been had I not gotten him that early intervention.......

[UGG]

Not sure how people get services without a diagnosis (formal or otherwise). Early intervention is key in such cases, so I'd say, the earlier the better.

He qualified for EI without a diagnosis. When he was evaluated, he showed severe delays in cognition, social and emotional behavior, and communication. In my state, EI cost is based on household income. We are charged $30 an hour which my insurance does not cover. With a diagnosis, my insurance will cover EI and I can get him more time with the therapist than we are getting now.

[UGG]

My son was tested when he was still an infant, I knew in my heart there was something not right with his development and I am thankful everyday I was strong enough to insist on seeing neurologists and specialists and not just be labelled as a nervous mom. When my son was diagnosed, I was just so thankful there were people out there who could help. He's 16 now and looking forward to getting his first car and going to college in 2014. My son will always have challenges due to his disability but when I think what could had been had I not gotten him that early intervention.......

Early Intervention is wonderful-the progress my son has made is amazing. He is still very behind but i no longer feel like I have a 9 month old-I literally felt like I had a 9 month old for 8 extra months. The other day he took my hand to walk down the hallway. I literally almost fell over. I was so happy to have such a normal moment with him.

[Ziggy]

I really hope they don't end up adding Premenstrual dysphoric disorder. Having half of the human population being potentially perceived as mentally ill just because they can experience very unpleasant menstrual related symptoms is beyond ridiculous. Of course the diagnostic criteria is supposed to be very strict but still.

Same with another wonderful idea of diagnosing personality disorders in young children... who don't have a personality developed yet.

With each edition of the DSM it is swelling and the spectrum of normality is becoming narrower and narrower. :/

Another suggestion is to shorten the grief period to one month IIRC. Traditionally we grieved for one year (in European culture anyway). It's 6 months at the moment but I guess the insurance companies don't want to pay for that long so they are lobbying to shorten it. I guess the big pharma wants exactly the opposite, it would be so interesting to observe all the backroom stuff and the lobbying going on between those two and APA.

Wow, I can't believe they're doing that! Doesn't sound like a very good idea . . .

Why? Asperger's is a very problematic and unclear diagnostical and clinical category and I believe that creating it in the first place was a very big mistake.

Of course it would have been better if it never existed than to go through the whole mess of removing it now.

Creating a spectrum for all autism related disorders is a much better idea IMO.

The problem I see with it is that, if you want to say that mental illness is a disease just like cancer, then you can't take every human behavior that presents on a continuum and draw an arbitrary line in the sand and say anyone whose behavior crosses that line has a disease.

They aren't and they never will be. They cannot be directly observed and at the end of the day, they are arbitrary and socially constructed. And by arbitrary I don't mean 'made up' but it's a specific group of people (heavily lobbied by the pharmaceutical and insurance industries) that decides which symptoms to bundle together into which disorder.

Being anti-social is not a disease. I think operating like this completely weakens the argument that mental illness is a disease. This is bad for people who have mental illnesses that actually are diseases because it makes it hard for them to be taken seriously and to get treatment.

Being anti-social can be a symptom of a disease. How do you decide which mental illnesses are "actually diseases" and which aren't?

IMO diagnosis of disease need to be saved for people whose bodies don't work right.

Health and disease are not just about the biomedical issues. Psychosocial factors are very important and should always be taken into consideration. There is plenty of research showing that psychosocial factors are responsible for the prevention/development/relapse/etc. of various diseases.

And as far as mental illness specifically goes, we still understand very little about how the brain works.

I think it's better to understand yourself, your personality, your traits and tendencies as a human being, rather than as a label. I also think it's better to try and understand others this way.

Whilst this is definitely true, as you will probably agree given your line of work, we also need the labels in order to know what to work with and how. Otherwise we'd have as many problems as there are clients/patients and whilst thinking idealistically that's how it should be, you have to consider the ways in which all of our institutions work. In most cases you will have very limited time and resources to provide treatment and you have to make the best use of them.

I do agree with you on the stigmatisation the labels give. And feeling like you need a disease label in order to be shown understanding and compassion from others. :/

That has got to be one of my biggest pet peeves. That, saying "my ADD has kicked in" when you get disorganized, and claiming to be "addicted" to something just because you like it a lot. It's the trifecta of mental illness as a personality trait.

All of those things come on a sliding scale of severity.

You can have certain OCD personality traits but not have an actual OCD diagnosis, for example.

I do love this picture of a psychology or psychiatry exam though:
http://img528.imageshack.us/img528/2...hologyexam.jpg

(My guess is that C would be the right answer)

[milanessa]

Another suggestion is to shorten the grief period to one month IIRC. Traditionally we grieved for one year (in European culture anyway). It's 6 months at the moment but I guess the insurance companies don't want to pay for that long so they are lobbying to shorten it. I guess the big pharma wants exactly the opposite, it would be so interesting to observe all the backroom stuff and the lobbying going on between those two and APA.

As an American I don't understand this at all.

[jeffisjeff]

I don't understand the claim that young children don't have a personality. Mine seemed to have quite distinct personalities at a young age. Is there a scientific definition of "having a personality"? Merriam Webster defines "personality" as "the quality or state of being a person."

[Ziggy]

As an American I don't understand this at all.

I'm sorry I wasn't being very clear there.

At the moment DSM states that for up to 6 months following the death of a close person, your mood might be adversely affected by that. So you might be experiencing something like a mild/moderate depression caused by that loss, basically. Which means that you are eligible to receive treatment that your insurance in many cases has to cover. Which is one of the reasons we need labels. An insurer (whether private or state) won't pay for treatment unless it's in the ICD-10 (this is the disease classification system developed by WHO that most countries in the world use, the mental illness part of it is based on DSM).

In the next edition of DSM, it has been proposed to shorten that period to 1 month. If that happens, then your insurer only has to pay for one month of counselling/therapy/anti-depressants instead of up to six. So that is definitely in their interest.

On the other hand, it is definitely in the interest of the pharmaceutical companies to create more and more new mental disorders because that increases their market. New diseases need new drugs to be treated with.

I don't understand the claim that young children don't have a personality. Mine seemed to have quite distinct personalities at a young age. Is there a scientific definition of "having a personality"? Merriam Webster defines "personality" as "the quality or state of being a person."

Yep there are personality theories in psychology and that's what I was referring to. Personality as a psychological construct is perceived to be quite stable but not really fully developed until late adolescence/early adulthood more or less (although that's hotly debated).

Introversion/extraversion is one of the personality traits in the "big five" theory which is the most common (neuroticism, openness, conscientiousness, agreeableness are the four others).

There's also a psychological construct called "temperament" and that is genetic and innate and is shown already in early childhood (some children will be very active and restless, others more quiet for example) and not really dependent on upbringing and life experiences.

[MacMadame]

With each edition of the DSM it is swelling and the spectrum of normality is becoming narrower and narrower. :/

This is part of my complaint.

Being anti-social can be a symptom of a disease. How do you decide which mental illnesses are "actually diseases" and which aren't?

In my world, it's a disease if you can be treated medically. Otherwise, it's just an issue that needs to be worked on.

I believe someday we'll understand mental illness much better and we'll find that they all have physiological causes that manifest themselves mentally. For example, it may be found that people who hear voices have some sort of neurological condition where their brain synapses don't fire correctly.

I fully acknowledge that I might be wrong. But this is my strong suspicion seeing how poorly therapy has treated people in my family while finding the right combination of pharmaceuticals has worked wonders.

(My guess is that C would be the right answer)

I prefer F.