DSM 5

dsm5

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.

psychiatry

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dsm-5_3d

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.

Standardization.

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.

A way back in 1952 the DSM-I came out.  download (1)

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. 

So next week the newest version of the DSM is to be released. The DSM 5. not letters this time, but a number. dsm-5-update_1

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.

hmmmm.

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? 

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About sensuousamberville

I am a Practitioner, teacher and student. I think we should always be students, we should keep our minds open, to continue to learn. :-)

14 responses »

  1. Up the creek, without a paddle?

    Reply
  2. So, grief is a mental disorder? That’s all kinds of screwed up. Grief is simply a natural reaction to loss, a process people go through. What’s disordered about that?

    Reply
    • For some, grief can turn into something stronger, but a label worries me. With the stigma attached, if someone that can benefit with some counselling is worried about the label that may be attached to them refuses to go… it is not so helpful.

      Reply
  3. That sounds like a lot of dissention. You mentioned it has happened with every release … but it seems more with this one. Is the National Institute on Mental Health a large organization then?

    Also, who is the publishing body? I would gather that much of this has gone through industry for comment … so they knew that opposition was likely? I take it also that it is only on portions of the DSM 5 that various groups are objecting to … why would they disregard the WHOLE of the guide? Are there other guides too then?

    I know …. I ask too many questions … it is just hard to see that either a lot of work has gone into something that many might not agree with and utilize.

    As for the tie in to billings and insurance … I admit, my first thought was Really? I can see that it might make coding treatments more standard … and again, I am not sure who is the group that is publishing this … but if there were individuals on the board who were connected with the insurance industry or pharmaceutical industries for instance … is there a conflict of interest? (Or a perceived conflict of interest.)

    And here is the kicker … if individuals that are NOT connected with pharmaceutical and insurance knowledge are not included….that too is not good I think, for they DO have a role to play. But perhaps this guide is not the place to address such things? (I TOTALLY admit I am out of my league here in what has gone into this Guide … I am just rambling and thinking out loud.)

    This is interesting … I wonder what will happen…

    Reply
    • lol, too many questions for a reply, i will need a new post I think. but yes there is a lot of politics involved unfortunately.

      I will do a post soon with the history of the dsm, it is interesting. The billing coding for the new manual, I think involves a lot of new entry. A massive amount. .

      Reply
      • Eeps….so this is where you will need to get a front office assistant to figure out all the codes? How do you digest all the information?

      • at this stage, I suspect many don’t know how billing will change, classification changes are being indicated, so insurance companies will need to address issues as well. we can use spread sheets? I read somewhere, how many entry changes were possible, I forget the number so I don’t want to write what I think it is….

      • *makes gurgly noises at the thought of spreadsheets*

        if spreadsheets are used … omg, it will not matter how many entries are needed. Excel is now almost limitless in the number of data you can use, as the….well…limits are:

        – Worksheet size 65,536 rows by 256 columns
        – Column width 255 characters

        But you can also have many worksheets opened and linked.

        Errr…ok…I know this blog post is not about spreadsheets … but you started it. Heh.

  4. I’ve been interested in the new DSM since I learnt it will contain a completely new way of defining BPD. According to the new definitions, my sister now has BPD too, whereas she didn’t meet the criteria before. The DSM should definitely be a guide, not a Bible. Will be interesting to see how it goes down.

    Reply

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