New Mental Disorders: Is Anyone “Sane” Left Standing?
By Pat Racimora on March 10, 2010 at 5:45 PM in Current Affairs
* Bumped Up *
Exactly what defines a mental disorder is determined by what the psychiatric profession dictates. And what it decides—whether you and your family are mentally firm or otherwise—may well impact your life now or in the future. The list of disorders changes from time to time, and that time is here again.
Are you on the extensive list of new mental disorders?
A psychiatric diagnosis determines in large measure the treatment plan (including drug prescriptions), whether insurance companies will pay for that treatment, and whether disability claims will be honored.
The American Psychiatric Association recently released their draft of Diagnostic and Statistical Manual of Mental Disorders V (DSM). This is the first revision since 1994 and will be finalized in 2013. It can remove what it had previously listed as a disorder (homosexuality was cut in the last version) and it can add new ones. Already the sparks are flying within the health professions as well as among outsiders.
It’s the new ones that have a lot of people clutching their heads.
Here is a partial list of proposed new mental disorders now under consideration:
Posttraumatic Stress Disorder in Preschool Children
Callous and Unemotional Specifier for Conduct Disorder
Learning Disabilities
Non-Suicidal Self Injury
Major Neurocognitive Disorder
Minor Neurocognitive Disorder
Mood Disorder Due to a General Medical Condition
Cannabis Withdrawal
Substance-Use Disorder
Amphetamine-Use Disorder
Cannabis-Use Disorder
Cocaine-Use Disorder
Hallucinogen-Use Disorder
Inhalant-Use Disorder
Nicotine-Use Disorder
Opioid-Use Disorder
Other (or Unknown) Substance-Use Disorder
Phencyclidine-Use Disorder
Polysubstance-Use Disorder
Sedative, Hypnotic, or Anxiolytic-Use Disorder
Psychosis Risk Syndrome
Hypersexual Disorder
Paraphilic Coercive Disorder
Sexual Interest/Arousal Disorder in Women
Sexual Interest/Arousal Disorder in Men
Genito-Pelvic Pain/Penetration Disorder
Binge Eating Disorder
Primary Central Sleep Apnea (previously Breathing Related Sleep Disorder)
Primary Alveolar Hypoventilation (previously Breathing Related Sleep Disorder)
Rapid Eye Movement Behavior Disorder
Restless Leg Syndrome
Circadian Rhythm Sleep Disorder – Advanced Sleep Phase Type
Disorder of Arousal
Circadiam Rhythm Sleep Disorder – Free-Running Type
Circadiam Rhythm Sleep Disorder – Irregular Sleep-Wake Type
Pathological Gambling
If we keep on adding to the already hundreds of other mental disorders slated to remain in the DSM, one is left to wonder what–if anything at all–would constitute sanity! For example, another new one, Mixed Anxiety Depressive Disorder, describes symptoms that are rather vague and common (we all have our downs and stresses), opening up an enormous potential pool of new patients. And that also means, of course, more business for service providers…
I share the following concerns about the proposed revision (and yes, we are entering into the subject matter of my day job, hence the passion):
1. More stigma. Considerable research shows that we continue to discriminate against people with mental problems, both socially and when it comes to employment opportunities. Psychiatric labels are stigmatizing, and confidentiality is difficult to guarantee anymore. So, should those, for example, with learning disabilities or restless leg syndrome be labled as mentally disordered? Parents are concerned because their children with Asperger’s Syndrome are currently slated to be grouped under “autism spectrum disorders,” a more stigmatizing diagnosis. Asperger’s is characterized by a lack of social skills (e.g., appear to lack empathy, are overly talkative, and have difficulty in reading social cues such as body language and facial expressions). Despite some similarities with autism, those with AS usually show normal language development and are often motivated to be social and friendly, characteristics that are almost the opposite of autism.
2. The dangers of “risk” labels. Whereas I can sympathize with taking preventive steps to avoid the full-blown manifestations of mental and physical problems, I have trouble with people at risk being labeled before the risk actually manifests itself. I can see young people being diagnosed with Psychosis Risk Syndrome, parents and teachers knowing about it, and creating a self-fulfilling prophecy along the way. That is, the kid thinks he’s headed for big trouble, the parents and teachers think so too, and treat him as such (also great way for them to avoid their responsibilities and shift all blame), so no one is surprised when the risks materialize. Correct diagnosis! And, is it even fair to stick a stigmatizing label on anyone who has not even been diagnosed with the “at risk” problem? We are all pre-something, after all.
3. Big Pharma will love all of these new diagnoses—more opportunities to create new products and be reimbursed for chemical symptom relief. Mild cases of diffuse disorders with symtoms that are common among people facing everyday stresses (mild depression or anxiety, for example) will prove to be a windfall to the already bulging profits enjoyed by drug companies. (Big Pharma rarely creates cures—not good for repeat business.)
4. Inclusion of behavior patterns that may not be disrupting or harmful. An example here is binge eating. Say you are upset with something going on in your life and find that eating makes you feel better. To be diagnosed as having a psychiatric eating disorder will now have a fairly low bar—briskly eating more within a 2 hour period than “most people would eat under similar circumstances,” feeling too full afterwards and doing it once a week for three months . Oops—I asked a few friends and most had fulfilled the criteria at some point, usually when stressed out.
5. Because people with legtimate psychiatric diagnoses may fall under the American Disabilities Act, will some of these diagnoses create more lawsuits because employers or other entities are not accommodating them? With my tongue firmly implanted in my cheek (although there have been plenty of crazy-ass law suits), I offer the following potential complaints:
Man with Hypersexual Disorder sues employer for not providing prostitutes during coffee breaks and the lunch hour.
Heavy marijuana smokers sue restaurant owner for hassling them about smoking pot at the dinner table.
Gambler seeks damages from the courts because his employer refused to give him time off to go to Las Vegas
OK, hopefully those are too whacky, but the DSM has legal and political consequences that need to be considered.
Having listed my criticisms, and in all fairness, we need a DSM. Without the “hard symptoms” we see in most physical illnesses, diagnoses and treatments of mental problems would be all over the place, and people who desperately need of services and treatments would not likely get any help from insurance companies or community agencies. The training mental health service providers would be a zoo.
The DSM gives mental and emotional problems solid credibility. But, I would hope that the psychiatric service providing community doesn’t ultimately include new ways to be labeled as mentally and emotionally impaired without a lot of soul-searching regarding the ramifications for vulnerable people (financially as well as emotionally) in true need of mental health services as well as avoiding netting those who don’t really need them.
That three more years remain for reflection and revision is a good thing.
by Ronald Scott
* More novels by 
* 
(
)
- You'll have access to 18 million movies, TV shows, songs, magazines, and books, as well as ultra-fast Web browsing with Amazon Silk -- faster than iPad. Full e-mail and document access and a keyboard. Fire can transmit what is on your screen onto a connected TV or monitor without an accessory. It runs Flash (iPad doesn't). 
