There is a New Psychiatric Bible – But Don’t Panic

This was published in the June 6, 2013 issue of the News-Record of Maplewood and South Orange.

When I first moved into Maplewood and met my new neighbors, I was surprised to learn that at least four of them were psychotherapists. Now, almost sixteen years later, homes on my block have been sold and even resold, and yet that number remains constant. Given the preponderance of mental health professionals in our area, it is understandable that many of us have been following the controversy over the latest edition of the so-called psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, which was published earlier this month by the American Psychiatric Association. We are not alone: Most major newspapers, news magazines and public radio stations have been caught up in the frenzy over the impact the changes in this manual, which is used to diagnose and inform the treatment of mental illness,  will have on professionals and patients alike.

Like many of my colleagues I dutifully registered for a course that highlights the major changes and have read the articles and listened to the interviews which range from panicked mothers who fear their children will lose their special services in school now that Asperger’s has been incorporated into autism spectrum disorder to psychologists bemoaning the fact that grief, a normal response to losing a loved one, can now be labeled a psychiatric disorder.   Others worry that the new childhood diagnosis of disruptive mood dysregulation disorder will label children with a tendency toward throwing tantrums beyond the preschool years, as mentally ill, while other new diagnoses such as binge eating, premenstrual dysphoric disorder, and caffeine withdrawal might lead us to conclude that perhaps we all should seek treatment. 

This fear mongering promotes provocative headlines and creates good fodder for bloggers and pundits, but the reality is that the DSM-5 will have little impact on either the psychiatric professional community or the clients that we treat. Here is why; unlike most other areas of healthcare, in psychiatry, psychology, clinical social work and counseling the treatment of clients is determined by the symptoms they present, not by their diagnosis. For example, if a sixteen-year-old girl presents with a pattern of extreme anger and irritability as well as periods of depression she will be given the same treatment, regardless of whether we use the old childhood bipolar disorder or the new disruptive mood dysregulation disorder diagnosis. Disruptive mood dysregulation was created to move children away from the bipolar (a serious mental illness) label, into another category of illness that may or may not ultimately develop into adult bipolar disorder. For diagnoses such as binge eating or premenstrual dysphoric disorder, the labels are new, but clients with these symptoms have been presenting themselves for treatment for quite some time – we just haven’t had precise diagnostic language until now.

When it comes to receiving services through the schools, I can only speak from my experience as a parent in the South Orange – Maplewood school district and as a therapist who has worked in schools and attended numerous Individual Education Plan (IEP) meetings. This experience has taught me that many school districts, including ours, look beyond the diagnostic labels and strive to provide students with all the services they need. Reports written by psychologists and psychiatrists, requesting services for children, are typically very detailed and descriptive and go far beyond a cursory checklist of diagnoses. These professionals recommend specific interventions, accommodations and services that will benefit the child. The Maplewood-South Orange school district has a reputation for being particularly committed to working with parents in finding the right accommodations for their children, and there is no reason to believe that new DSM language will have any impact on the services they provide. Similarly, there’s no reason to anticipate any changes in insurance coverage based on these new diagnoses.

The biggest impact of the new DSM-5 may be on those individuals who feel bonded with their diagnosis. What will happen to the self proclaimed “Aspie” who no longer has Asperger’s? How about the bipolar teen who is now disruptive mood dysregulated? Will the Aspie be distressed that he is now labeled as autistic? Will the bipolar teen now feel optimistic about her new milder sounding mood dysregulation? Grappling with a change in diagnosis is not always easy and may take some time.

Perhaps the most important lesson that those of us who love and or support and treat those with mental illness can take away from all this change is that no one should be defined by their diagnosis. While a psychiatric illness may at times place limitations on life, it needn’t become one’s identity; for we and our families and our clients and our neighbors are so much more than any one illness, we are so much more than any one diagnosis, we are so much more than anything that could be described in a few paragraphs in any one book – even the DSM-5. 



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