Whats all the hubbub?
You are probably hearing now on the news some controversial talk or have seen some interviews about this “DSM 5” thing.
So what is it? why is there buzz?
Whats going on?
wait you haven’t heard? eeeps.
I mentioned the DSM a few posts ago. DSM is The Diagnostic and Statistical Manual of Mental Disorders. A guide.
Some call it a bible. I think a guide is a better reference. Flexibly is needed, we are all different. We are not to the stage where we can call it fact, this is it, it is this or that, not in between or this and a bit of that. Confusing right? well it is.
The DSM “helps” us diagnose mental illness, disorders. It also is hoped that it offers parameters so that if I diagnose a mental illness in a patient, and they visit someone else… anywhere in the world, the diagnosis will be the same.
A good thing right?
The DSM is also used for billing purposes. This is where a lot of the controversy is originating. Insurance and governments need a diagnosis/label for billing purposes. dot the i’s and such.
Working through updates we worked up to the DSM 4. Version three and four had r’s attached as they were revised. We are working with the DSM-IV-TR now, since 2000.
Just some background information as I know you are super excited. 😉
It is important though. To have a guide.
Some will say a diagnosis or label can be damaging, we do not need a guide, just treat the symptoms.
hmmmm. but you can’t really do that, treating the cause of the symptoms would be the answer.
An example, that always helps.
A patient is rapid cycling, ultradian cycling (more than once a day). To treat the symptom a mood stabilizer can be prescribed right? stabilize the mood cycling, perhaps treating it as bipolar… but if it is borderline, where ultradian cycling will also occur, the meds are not the right treatment. Oh they can help the symptoms, but with BPD therapy is needed. Just medicating the symptoms is not going to help the patient.
So a diagnosis is required. Treating just the symptoms is not the answer. A diagnosis that is standard is also helpful. Treatment can be refined.
We are still learning, we have made great leaps, but we have a long way to go, maybe one day we can plug into a computer of some sort for a scan, get a hypo-spray and walk away with a smile. All better.
not today though.
There are some changes in it of course. Some are making some waves. I mentioned billing, this will concern many people. If the DSM changes the label it also may change the care you can receive. Insurance or therapy. Aspergers may vanish and be replaced by low level autism. Coverage may not be the same, just words perhaps, but changing labels can have ramifications.
A new child mental illness may make it into the DSM 5 disruptive mood dysregulation disorder. This is being addressed as there is concern at diagnosing a child with bioplar and prescribing anti-psychotic drugs. Ok but if the child does have Bipolar and the crutch is now to diagnosis with disrputive mood dysregulation .. is it going to help? It becomes easy to slap on a quick label sometimes, this is not the right way.
Grief is being added as a disorder.
The DSM 5 is being hotly discussed, There are huge boycotts set up for it. The National Institute on Mental Health has advised that they are not going to use the DSM 5 for their research models. In other words… they are not going to support it.
This new guide though represents a lot of work. The DSM IV-TR listed close to 300 disorders. Many mental health professionals are not going to even look at the new release, so the concept of making diagnosis standard is going to go out the window.
Where does that leave everyone?